Provider Demographics
NPI:1306830401
Name:VINICK, THOMAS OSBORN (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:OSBORN
Last Name:VINICK
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 1:112 CURRITUCK COMMERICAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOYOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27958-8748
Mailing Address - Country:US
Mailing Address - Phone:252-435-6131
Mailing Address - Fax:252-435-6852
Practice Address - Street 1:112 CURRITUCK COMMERICAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:MOYOCK
Practice Address - State:NC
Practice Address - Zip Code:27958-8748
Practice Address - Country:US
Practice Address - Phone:252-435-6131
Practice Address - Fax:252-435-6852
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2318111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890822QMedicaid
NC2451020AMedicare ID - Type Unspecified
NCU-59362Medicare UPIN