Provider Demographics
NPI:1447356365
Name:TOOLE, DOUGLAS J (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:J
Last Name:TOOLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 MARSH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-6271
Mailing Address - Country:US
Mailing Address - Phone:219-548-4404
Mailing Address - Fax:219-548-4405
Practice Address - Street 1:1052 MARSH ST
Practice Address - Street 2:SUITE E
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-6271
Practice Address - Country:US
Practice Address - Phone:219-548-4404
Practice Address - Fax:219-548-4405
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001761A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200150AMedicare ID - Type Unspecified
INU70456Medicare UPIN