Provider Demographics
NPI:1063685246
Name:SPERRY, THOMAS BURTON (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BURTON
Last Name:SPERRY
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 1:2585 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1708
Mailing Address - Country:US
Mailing Address - Phone:630-729-7024
Mailing Address - Fax:630-963-4420
Practice Address - Street 1:2585 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1708
Practice Address - Country:US
Practice Address - Phone:630-729-7024
Practice Address - Fax:630-963-4420
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005498111NR0400X
IL038-005498111NS0005X, 111NR0400X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Medicare UPIN