Provider Demographics
NPI:1083850754
Name:SPIRIDELLIS, THOMAS EVANS (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:EVANS
Last Name:SPIRIDELLIS
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 1:162 W 56TH ST
Mailing Address - Street 2:301
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3831
Mailing Address - Country:US
Mailing Address - Phone:212-245-5520
Mailing Address - Fax:212-245-5570
Practice Address - Street 1:162 W 56TH ST
Practice Address - Street 2:301
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3831
Practice Address - Country:US
Practice Address - Phone:212-245-5520
Practice Address - Fax:212-245-5570
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13-3338801OtherTAX ID