Provider Demographics
NPI:1043258288
Name:TAGUE, THOMAS PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PETER
Last Name:TAGUE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:T.PETER
Other - Middle Name:
Other - Last Name:TAGUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3100 GERYVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:PENNSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18073-2609
Mailing Address - Country:US
Mailing Address - Phone:215-679-0702
Mailing Address - Fax:215-646-8328
Practice Address - Street 1:878 WELSH RD
Practice Address - Street 2:
Practice Address - City:MAPLE GLEN
Practice Address - State:PA
Practice Address - Zip Code:19002
Practice Address - Country:US
Practice Address - Phone:215-646-4460
Practice Address - Fax:215-646-8328
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001838L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0048537000OtherHMO ID
PA0048537000OtherHMO ID