Provider Demographics
NPI:1689692709
Name:DAHL, THOMAS EDWARD (DC, FI,ACA)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:DAHL
Suffix:
Gender:M
Credentials:DC, FI,ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 W UNION HILLS DR
Mailing Address - Street 2:STE 13
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4899
Mailing Address - Country:US
Mailing Address - Phone:623-582-6141
Mailing Address - Fax:623-581-1924
Practice Address - Street 1:3414 W UNION HILLS DR
Practice Address - Street 2:STE 13
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4899
Practice Address - Country:US
Practice Address - Phone:623-582-6141
Practice Address - Fax:623-581-1924
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2010-04-21
Deactivation Date:2010-03-02
Deactivation Code:
Reactivation Date:2010-04-21
Provider Licenses
StateLicense IDTaxonomies
AZ4405111N00000X
AZ124171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ23-07-4405OtherWORKERS COMPENSATION
AZ860616603OtherFEDERAL TAX ID
AZAZ0246870OtherBC/BS OF AZ
AZAZ0246870OtherBC/BS OF AZ