Provider Demographics
NPI:1164582011
Name:THOMAS, SIE YEON (DC)
Entity Type:Individual
Prefix:DR
First Name:SIE
Middle Name:YEON
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SIE
Other - Middle Name:YEON
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 732917
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2917
Mailing Address - Country:US
Mailing Address - Phone:972-623-8974
Mailing Address - Fax:
Practice Address - Street 1:2525 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-2693
Practice Address - Country:US
Practice Address - Phone:214-327-4503
Practice Address - Fax:214-370-2683
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9122111NR0400X
TX783003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111NR0400XChiropractic ProvidersChiropractorRehabilitation