Provider Demographics
NPI:1588600910
Name:PREBECK, THOMAS O (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:O
Last Name:PREBECK
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 1:5322 HIGHGATE DR
Mailing Address - Street 2:SUITE145
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6633
Mailing Address - Country:US
Mailing Address - Phone:919-544-9355
Mailing Address - Fax:919-544-9494
Practice Address - Street 1:5322 HIGHGATE DR
Practice Address - Street 2:SUITE145
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6633
Practice Address - Country:US
Practice Address - Phone:919-544-9355
Practice Address - Fax:919-544-9494
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2295111N00000X
NYX008147111N00000X
VA1528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0823JOtherBLUE CROSS & BLUE SHIELD
NC890823JMedicaid
NC0823JOtherBLUE CROSS & BLUE SHIELD