Provider Demographics
NPI:1467588426
Name:O'MALLEY, THOMAS P (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
Last Name:O'MALLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:80 WORCESTER ST
Mailing Address - Street 2:SUITE#2
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-1041
Mailing Address - Country:US
Mailing Address - Phone:508-839-0040
Mailing Address - Fax:508-839-0043
Practice Address - Street 1:80 WORCESTER ST
Practice Address - Street 2:SUITE#2
Practice Address - City:NORTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536-1041
Practice Address - Country:US
Practice Address - Phone:508-839-0040
Practice Address - Fax:508-839-0043
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2556111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7261412OtherAETNA
MA043579486OtherTAX IDENTIFICATION NUMBER
MA2046485OtherFIRST HEALTH CCN
MA351415OtherHARVARD PILGRIM HEALTHCAR
MAY36831OtherBLUE CROSS BLUE SHIELD
MA043579486OtherTAX IDENTIFICATION NUMBER
MA351415OtherHARVARD PILGRIM HEALTHCAR