Provider Demographics
NPI:1578649182
Name:MCGILLICK, THOMAS C (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:MCGILLICK
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 1:2 HOLLYWOOD BLVD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-4839
Mailing Address - Country:US
Mailing Address - Phone:609-971-7722
Mailing Address - Fax:
Practice Address - Street 1:2 HOLLYWOOD BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-4839
Practice Address - Country:US
Practice Address - Phone:609-971-7722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45646Medicare UPIN
NJMC517648Medicare ID - Type UnspecifiedMEDICARE