Provider Demographics
NPI:1427384544
Name:THOMAS, MICHAEL ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
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 1:3390 STRATFORD RD NE
Mailing Address - Street 2:604
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1730
Mailing Address - Country:US
Mailing Address - Phone:770-595-5540
Mailing Address - Fax:
Practice Address - Street 1:3390 STRATFORD RD NE
Practice Address - Street 2:604
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1730
Practice Address - Country:US
Practice Address - Phone:770-595-5540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008424111N00000X
MI2301009549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor