Provider Demographics
NPI:1508084435
Name:THOMAS, BRUCE LLOYD (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LLOYD
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 1:1452 OAKFIELD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-244-9164
Mailing Address - Fax:813-409-3887
Practice Address - Street 1:1452 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4853
Practice Address - Country:US
Practice Address - Phone:813-409-3888
Practice Address - Fax:813-409-3887
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU33750Medicare UPIN