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General NPI Number Information
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NPI Number | 1871588871
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Entity Type | Individual
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Provider Name | THOMAS JOHN LEUTHNER D.C.
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Gender | Male
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Dates
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Enumeration Date | 09/15/2005
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Last Update Date | 07/09/2010
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Provider Practice Location Address
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Address Line | 1792 E MASON ST
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City | GREEN BAY
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State | WI
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Zip | 54302-3251
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Country | US
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Telephone | 920-468-1967
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Fax | 920-468-0405
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Provider Business Mailing Address
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Address Line | 1792 E MASON ST
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City | GREEN BAY
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State | WI
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Zip | 54302-3251
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Country | US
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Telephone | 920-468-1967
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Fax | 920-468-0405
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2252
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License Number State | WI
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