Provider Demographics
NPI:1083649438
Name:THOMAS, CHRISTOPHER WAYNE (DC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:WAYNE
Last Name:THOMAS
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 1:3713 CALUMET AVENUE
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-5433
Mailing Address - Country:US
Mailing Address - Phone:920-682-6680
Mailing Address - Fax:920-682-6983
Practice Address - Street 1:3713 CALUMET AVENUE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5433
Practice Address - Country:US
Practice Address - Phone:920-682-6680
Practice Address - Fax:920-682-6983
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1534012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38761900Medicaid
WI38761900Medicaid
WI000035574Medicare ID - Type Unspecified