Provider Demographics
NPI:1083687701
Name:HOFMEISTER, THEA ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:THEA
Middle Name:ROSE
Last Name:HOFMEISTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3012
Mailing Address - Country:US
Mailing Address - Phone:615-904-5181
Mailing Address - Fax:
Practice Address - Street 1:817 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1032
Practice Address - Country:US
Practice Address - Phone:615-563-4443
Practice Address - Fax:615-563-4550
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635686OtherBC/BS PROVIDER #
IL01635686OtherBC/BS PROVIDER #
IL212553Medicare ID - Type UnspecifiedMEDICARE PROVIDER #