Provider Demographics
NPI:1275622151
Name:THOMAS, SUBY JACOB (DC)
Entity Type:Individual
Prefix:DR
First Name:SUBY
Middle Name:JACOB
Last Name:THOMAS
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 1:18885 STONEWATER BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8557
Mailing Address - Country:US
Mailing Address - Phone:248-912-0075
Mailing Address - Fax:
Practice Address - Street 1:670 GRISWOLD ST STE 200
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2687
Practice Address - Country:US
Practice Address - Phone:248-912-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI020687862OtherTAX ID
MI142319OtherCARE CHOICES' PIN
MI950H216160OtherBCBS PIN
MION82320Medicare PIN
MI020687862OtherTAX ID