Provider Demographics
NPI:1407827371
Name:ROSPLOCK, THOMAS M (DC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:M
Last Name:ROSPLOCK
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 1:1428 PHILLIPS LN STE B1
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2572
Mailing Address - Country:US
Mailing Address - Phone:805-548-8520
Mailing Address - Fax:
Practice Address - Street 1:1428 PHILLIPS LN STE B1
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2572
Practice Address - Country:US
Practice Address - Phone:805-548-8520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0257910Medicaid
CADC0257910Medicaid