Provider Demographics
NPI:1376725036
Name:AYRES, THOMAS OWEN (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:OWEN
Last Name:AYRES
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 1:3495 WILLOW LAKE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55110-5138
Mailing Address - Country:US
Mailing Address - Phone:651-766-3855
Mailing Address - Fax:651-766-7884
Practice Address - Street 1:3495 WILLOW LAKE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55110-5138
Practice Address - Country:US
Practice Address - Phone:651-766-3855
Practice Address - Fax:651-766-7884
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor