Provider Demographics
NPI:1073547329
Name:CANSECO, THOMAS P (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:CANSECO
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 1:4453 PENN AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-8620
Mailing Address - Country:US
Mailing Address - Phone:610-750-6804
Mailing Address - Fax:610-750-5295
Practice Address - Street 1:4453 PENN AVE STE 6
Practice Address - Street 2:
Practice Address - City:SINKING SPRING
Practice Address - State:PA
Practice Address - Zip Code:19608-8620
Practice Address - Country:US
Practice Address - Phone:610-750-6804
Practice Address - Fax:610-750-5295
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009154111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAV03970Medicare UPIN
PA088409J12Medicare PIN