Provider Demographics
NPI:1871588871
Name:LEUTHNER, THOMAS JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:LEUTHNER
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 1:1792 E MASON ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-3251
Mailing Address - Country:US
Mailing Address - Phone:920-468-1967
Mailing Address - Fax:920-468-0405
Practice Address - Street 1:1792 E MASON ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-3251
Practice Address - Country:US
Practice Address - Phone:920-468-1967
Practice Address - Fax:920-468-0405
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38885300Medicaid
WI38885300Medicaid
WI000135649Medicare ID - Type Unspecified