1801959820 NPI number — DR. NEIL M THOMAS D.C.

Table of content: DR. NEIL M THOMAS D.C. (NPI 1801959820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801959820 NPI number — DR. NEIL M THOMAS D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
NEIL
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801959820
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9500 N 129TH EAST AVE
Provider Second Line Business Mailing Address:
STE 109
Provider Business Mailing Address City Name:
OWASSO
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74055-5376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-376-4117
Provider Business Mailing Address Fax Number:
918-376-4127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9500 N 129TH EAST AVE
Provider Second Line Business Practice Location Address:
STE 109
Provider Business Practice Location Address City Name:
OWASSO
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74055-5376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-376-4117
Provider Business Practice Location Address Fax Number:
918-376-4127
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4112 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 41253 . This is a "BLUE CROSS BLUE SHIELD #" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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