Provider Demographics
NPI:1033285259
Name:THOMAS, RODNEY B JR (DC)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:B
Last Name:THOMAS
Suffix:JR
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 1:770 CAREW ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-1948
Mailing Address - Country:US
Mailing Address - Phone:413-733-1181
Mailing Address - Fax:413-733-6676
Practice Address - Street 1:770 CAREW ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-1948
Practice Address - Country:US
Practice Address - Phone:413-733-1181
Practice Address - Fax:413-733-6676
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1960111N00000X
CT001876111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9725181Medicaid
MA9725181Medicaid