Provider Demographics
NPI:1679561377
Name:ERNDT, THOMAS W (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:ERNDT
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 1:123 STATE ROUTE 3
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074
Mailing Address - Country:US
Mailing Address - Phone:740-965-4301
Mailing Address - Fax:740-965-5182
Practice Address - Street 1:123 STATE ROUTE 3
Practice Address - Street 2:SUITE A
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074
Practice Address - Country:US
Practice Address - Phone:740-965-4301
Practice Address - Fax:740-965-5182
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH880111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0489476Medicaid
OHER0499893Medicare PIN
OH0489476Medicaid