Provider Demographics
NPI:1417919937
Name:MAGUIRE, THOMAS AQUINAS (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:AQUINAS
Last Name:MAGUIRE
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 1:2825 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3229
Mailing Address - Country:US
Mailing Address - Phone:305-667-4584
Mailing Address - Fax:305-693-0033
Practice Address - Street 1:2825 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3229
Practice Address - Country:US
Practice Address - Phone:305-667-4584
Practice Address - Fax:305-693-8362
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050376200Medicaid
FLT96765Medicare UPIN
FL88988Medicare ID - Type Unspecified