Provider Demographics
NPI:1285023523
Name:THOM, MICHAEL DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DANIEL
Last Name:THOM
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 1:2140 EGGERT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2055
Mailing Address - Country:US
Mailing Address - Phone:716-832-1818
Mailing Address - Fax:716-832-7815
Practice Address - Street 1:2140 EGGERT RD
Practice Address - Street 2:SUITE B
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-2055
Practice Address - Country:US
Practice Address - Phone:716-832-1818
Practice Address - Fax:716-832-7815
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70012317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor