Provider Demographics
NPI:1568520997
Name:THOMAS, MATTHEW STEPHEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:STEPHEN
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 1:178 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:ME
Mailing Address - Zip Code:04861-3811
Mailing Address - Country:US
Mailing Address - Phone:207-354-5179
Mailing Address - Fax:
Practice Address - Street 1:178 MAIN ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:ME
Practice Address - Zip Code:04861-3811
Practice Address - Country:US
Practice Address - Phone:207-354-5179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950C110200OtherBCBS
MIP00320619OtherRAILROAD MEDICARE
MIN48710003Medicare ID - Type Unspecified