Provider Demographics
NPI:1639209364
Name:HOVER, THOMAS DEE (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DEE
Last Name:HOVER
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 1:1801 WEST KNAPP STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-1381
Mailing Address - Country:US
Mailing Address - Phone:715-234-3067
Mailing Address - Fax:715-736-0960
Practice Address - Street 1:1801 WEST KNAPP STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1381
Practice Address - Country:US
Practice Address - Phone:715-234-3067
Practice Address - Fax:715-736-0960
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38762000Medicaid
391367657OtherFEDERAL EMPLOYER ID
T62095Medicare UPIN
WI38762000Medicaid