Provider Demographics
NPI:1417977117
Name:THOMAS, RICHARD A (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:THOMAS
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 1:2836 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-2112
Mailing Address - Country:US
Mailing Address - Phone:727-786-2410
Mailing Address - Fax:
Practice Address - Street 1:2445 TAMPA RD STE J
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-5849
Practice Address - Country:US
Practice Address - Phone:727-785-8800
Practice Address - Fax:727-787-1093
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT56038Medicare UPIN
FL88964Medicare ID - Type Unspecified