Provider Demographics
NPI:1053485805
Name:PERRAULT, THOMAS S JR (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
Last Name:PERRAULT
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 1:76 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-4239
Mailing Address - Country:US
Mailing Address - Phone:978-686-7791
Mailing Address - Fax:978-975-0468
Practice Address - Street 1:76 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-4239
Practice Address - Country:US
Practice Address - Phone:978-686-7791
Practice Address - Fax:978-975-0468
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT84810Medicare UPIN