Provider Demographics
NPI:1619031200
Name:LEGROW, THOMAS WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:LEGROW
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 1:400 CRUTCHFIELD ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2771
Mailing Address - Country:US
Mailing Address - Phone:919-620-7900
Mailing Address - Fax:919-479-5061
Practice Address - Street 1:400 CRUTCHFIELD ST
Practice Address - Street 2:SUITE D
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2771
Practice Address - Country:US
Practice Address - Phone:919-620-7900
Practice Address - Fax:919-479-5061
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08513OtherBCBS PROVIDER #
NC08513OtherBCBS PROVIDER #