Provider Demographics
NPI:1740384346
Name:THOMAS, MARK ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
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 1:4624 LEBANON PIKE
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1316
Mailing Address - Country:US
Mailing Address - Phone:615-883-8555
Mailing Address - Fax:615-883-7155
Practice Address - Street 1:4624 LEBANON PIKE
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1316
Practice Address - Country:US
Practice Address - Phone:615-883-8555
Practice Address - Fax:615-883-7155
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU78640Medicare UPIN
TN3970965Medicare ID - Type Unspecified