Provider Demographics
NPI:1639247240
Name:PAPPAS, TOM DAN (DC)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:DAN
Last Name:PAPPAS
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 1:5237 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-4210
Mailing Address - Country:US
Mailing Address - Phone:773-286-7118
Mailing Address - Fax:773-286-1287
Practice Address - Street 1:5237 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4210
Practice Address - Country:US
Practice Address - Phone:773-286-7118
Practice Address - Fax:773-286-1287
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621673OtherBLUE CROSS BLUE SHIELD
IL313840Medicare ID - Type UnspecifiedMEDICARE
ILU67502Medicare UPIN