Provider Demographics
NPI:1619341062
Name:THOMAS, SHAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 OLD CLEMSON HIGHWAY
Mailing Address - Street 2:STE E #211
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672-7708
Mailing Address - Country:US
Mailing Address - Phone:864-633-0212
Mailing Address - Fax:
Practice Address - Street 1:315 COVEVIEW COURT
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:SC
Practice Address - Zip Code:29676
Practice Address - Country:US
Practice Address - Phone:864-633-0212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009606111N00000X
SC4389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor