Provider Demographics
NPI:1154469047
Name:THOMAS, RICHARD J (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
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 1:804 STILLWATER AVENUE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-942-7525
Mailing Address - Fax:207-990-2308
Practice Address - Street 1:804 STILLWATER AVENUE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-942-7525
Practice Address - Fax:207-990-2308
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR774111N00000X
NC1693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000990OtherANTHEM BLUE CROSS BLUE SH
MEMM2740Medicare ID - Type Unspecified
T88472Medicare UPIN