Provider Demographics
NPI:1376693291
Name:CHEW, THOMAS C (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:CHEW
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15550 ROCKFIELD BLVD
Mailing Address - Street 2:B220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2720
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:3540 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2010
Practice Address - Country:US
Practice Address - Phone:510-628-8460
Practice Address - Fax:510-268-8591
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC17058OtherCHIROPRACTIC LICENSE
CADC0170580Medicare ID - Type Unspecified