Provider Demographics
NPI:1457486615
Name:EDWARDS, THOMAS JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:EDWARDS
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 1:21195 WATERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1898
Mailing Address - Country:US
Mailing Address - Phone:262-784-3277
Mailing Address - Fax:262-784-1957
Practice Address - Street 1:21195 WATERTOWN RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1898
Practice Address - Country:US
Practice Address - Phone:262-784-3277
Practice Address - Fax:262-784-1957
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
06-1166362OtherFEDERAL TAX ID
WI75-829Medicare ID - Type Unspecified
06-1166362OtherFEDERAL TAX ID