Provider Demographics
NPI:1013043645
Name:OLIVER, THOMAS CLARK (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CLARK
Last Name:OLIVER
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 1:3020 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-3639
Mailing Address - Country:US
Mailing Address - Phone:209-466-1234
Mailing Address - Fax:209-466-6181
Practice Address - Street 1:3020 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-4919
Practice Address - Country:US
Practice Address - Phone:209-466-1234
Practice Address - Fax:209-466-6181
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0264630Medicaid
CADC0264630Medicaid