Provider Demographics
NPI:1053452490
Name:TRUMAN, JON TIMOTHY (DC)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:TIMOTHY
Last Name:TRUMAN
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:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:PEMBERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43450-0415
Mailing Address - Country:US
Mailing Address - Phone:419-287-3216
Mailing Address - Fax:419-287-3216
Practice Address - Street 1:131 E FRONT ST
Practice Address - Street 2:
Practice Address - City:PEMBERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43450-0415
Practice Address - Country:US
Practice Address - Phone:419-287-3216
Practice Address - Fax:419-287-3216
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000127623OtherANTHEM BCBS
OH341121454003OtherMEDICAL MUTUAL
OH02785OtherPARAMOUNT HEALTH CARE
OH34112145400OtherBWC
OH0197586Medicaid
OH341121454003OtherMEDICAL MUTUAL
OH34112145400OtherBWC