Provider Demographics
NPI:1639246432
Name:CALLAGHAN, THOMAS MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:CALLAGHAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:
Other - Last Name:CALLAGHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:357 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1506
Mailing Address - Country:US
Mailing Address - Phone:518-792-1691
Mailing Address - Fax:518-792-1861
Practice Address - Street 1:357 RIDGE RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1506
Practice Address - Country:US
Practice Address - Phone:518-792-1691
Practice Address - Fax:518-792-1861
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3896111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1048881OtherAMERICAN SPECIALITY HEALT
NY10031948OtherCDPHP
NY126122OtherACN
NYX46511OtherEMPIRE
NY10031948OtherCDPHP
NY1048881OtherAMERICAN SPECIALITY HEALT