Tony Dejtiranukul, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4008 Issued in OH

Practice address

990 Belvedere Dr Ste B
Lebanon, OH 45036-1193

Phone

(513) 836-8844

Fax

(513) 836-8845

NPI assigned

Jan 23, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Specialty

Chiropractic

Education

Logan College of Chiropractic, 2008

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Countryside Clinic of Chiropractic, LLC

  • Chiropractor
  • Lebanon, OH
  • NPI 1063837367
  Medicare reassignment Authorized official
• East Kemper Chiropractic Inc

  • Chiropractor
  • Cincinnati, OH
  • NPI 1063626372
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770854400000",
    "number": "1497086953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 BELVEDERE DR STE B",
            "city": "LEBANON",
            "state": "OH",
            "postal_code": "450361193",
            "telephone_number": "513-836-8844",
            "fax_number": "513-836-8845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 BELVEDERE DR STE B",
            "city": "LEBANON",
            "state": "OH",
            "postal_code": "450361193",
            "telephone_number": "513-836-8844",
            "fax_number": "513-836-8845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEJTIRANUKUL",
        "first_name": "TONY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-01-23",
        "last_updated": "2026-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OH",
            "license": "4008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Lebanon, OH
• Providers in Lebanon, OH by specialty
• Chiropractor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.