Provider Demographics
NPI:1508868449
Name:THOMAS, JOSEPH JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHN
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 1:332 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:JOSHUA
Mailing Address - State:TX
Mailing Address - Zip Code:76058-3047
Mailing Address - Country:US
Mailing Address - Phone:817-641-1313
Mailing Address - Fax:817-641-1314
Practice Address - Street 1:332 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:JOSHUA
Practice Address - State:TX
Practice Address - Zip Code:76058-3047
Practice Address - Country:US
Practice Address - Phone:817-641-1313
Practice Address - Fax:817-641-1314
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008872111N00000X
TX12472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019172440001Medicaid
PA1394440OtherBLUE SHIELD
PA059884KNEMedicare ID - Type Unspecified
PA0019172440001Medicaid