Provider Demographics
NPI:1679255269
Name:THOMAS, STONE DYLAN (DC)
Entity Type:Individual
Prefix:DR
First Name:STONE
Middle Name:DYLAN
Last Name:THOMAS
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 1:1835 NEWPORT BLVD SUITE D-263,
Mailing Address - Street 2:10
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627
Mailing Address - Country:US
Mailing Address - Phone:949-996-7166
Mailing Address - Fax:
Practice Address - Street 1:1835 NEWPORT BLVD SUITE D-263,
Practice Address - Street 2:10
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-9262
Practice Address - Country:US
Practice Address - Phone:949-205-9265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor