Provider Demographics
NPI:1588618771
Name:BICKEL, THOMAS G (DC,CCSP)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:BICKEL
Suffix:
Gender:M
Credentials:DC,CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 S WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08106-1352
Mailing Address - Country:US
Mailing Address - Phone:856-547-7722
Mailing Address - Fax:856-547-6607
Practice Address - Street 1:246 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:NJ
Practice Address - Zip Code:08106-1352
Practice Address - Country:US
Practice Address - Phone:856-547-7722
Practice Address - Fax:856-547-6607
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00349300111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU27505Medicare UPIN
NJ708460AC5Medicare ID - Type UnspecifiedPROVIDER NUMBER