Provider Demographics
NPI:1194716951
Name:KEMP, THOMAS W (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:KEMP
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 1:1044 N ESKEW RD
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-7707
Mailing Address - Country:US
Mailing Address - Phone:812-897-1700
Mailing Address - Fax:812-897-0071
Practice Address - Street 1:1044 N ESKEW RD
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-7707
Practice Address - Country:US
Practice Address - Phone:812-897-1700
Practice Address - Fax:812-897-0071
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002171A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000354639OtherBLUE CROSS BLUE SHIELD
INV03640Medicare UPIN
IN223020Medicare ID - Type Unspecified