Provider Demographics
NPI:1063507275
Name:WOOLHISER, THOMAS FROST (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:FROST
Last Name:WOOLHISER
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 1:611 NW 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6160
Mailing Address - Country:US
Mailing Address - Phone:954-438-3010
Mailing Address - Fax:954-438-4679
Practice Address - Street 1:611 NW 99TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6160
Practice Address - Country:US
Practice Address - Phone:954-438-3010
Practice Address - Fax:954-438-4679
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLC0006582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380590500Medicaid
FLCH0006582OtherSTATE LICENSE
FL22955Medicare ID - Type Unspecified
FL380590500Medicaid