Provider Demographics
NPI:1306861984
Name:MUNCY, THOMAS L II (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:MUNCY
Suffix:II
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 1:300 MOORE ST STE B
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-4337
Mailing Address - Country:US
Mailing Address - Phone:276-591-5448
Mailing Address - Fax:
Practice Address - Street 1:300 MOORE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-4495
Practice Address - Country:US
Practice Address - Phone:276-591-5448
Practice Address - Fax:276-591-5447
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA146646OtherBLUE CROSS BLUE SHIELD
VA146646OtherBLUE CROSS BLUE SHIELD