Provider Demographics
NPI:1437208774
Name:SANDBERG, THOMAS M (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:SANDBERG
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 1:5815 W WILLIAM CANNON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1966
Mailing Address - Country:US
Mailing Address - Phone:512-301-5996
Mailing Address - Fax:512-301-5692
Practice Address - Street 1:5815 W WILLIAM CANNON DR STE 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1966
Practice Address - Country:US
Practice Address - Phone:512-301-5996
Practice Address - Fax:512-301-5692
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64846111N00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU95292Medicare UPIN
TX00955HMedicare ID - Type Unspecified