Provider Demographics
NPI:1003808577
Name:THOMAS, CHERIE LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHERIE
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:F
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 276
Mailing Address - Street 2:
Mailing Address - City:AVIS
Mailing Address - State:PA
Mailing Address - Zip Code:17721-0276
Mailing Address - Country:US
Mailing Address - Phone:570-753-8311
Mailing Address - Fax:
Practice Address - Street 1:2859 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-8547
Practice Address - Country:US
Practice Address - Phone:570-753-8311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003422L111N00000X
PAAJ003422L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010848830001Medicaid
PA808657OtherFIRST PRIORITY HEALTH
PAT30022Medicare UPIN
PA0010848830001Medicaid
PA350012756Medicare ID - Type UnspecifiedRAILROAD MEDICARE