Provider Demographics
NPI:1114064011
Name:BOBER, THOMAS EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:BOBER
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 1:1046 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02655-1587
Mailing Address - Country:US
Mailing Address - Phone:508-420-0495
Mailing Address - Fax:
Practice Address - Street 1:1046 MAIN ST
Practice Address - Street 2:
Practice Address - City:OSTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02655-1587
Practice Address - Country:US
Practice Address - Phone:508-420-0495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36515OtherBCBS
MAY36515OtherBCBS
MAY45119Medicare ID - Type Unspecified