Provider Demographics
NPI:1609952399
Name:LAROSA, THOMAS J (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:LAROSA
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:PO BOX 1272
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-1272
Mailing Address - Country:US
Mailing Address - Phone:845-744-2244
Mailing Address - Fax:845-744-6153
Practice Address - Street 1:76 BONIFACE DR STE 2
Practice Address - Street 2:
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566-4611
Practice Address - Country:US
Practice Address - Phone:845-744-2244
Practice Address - Fax:845-744-6153
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor