Provider Demographics
NPI:1750458477
Name:JOE, THOMAS J (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:JOE
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 1:89 RIVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1292
Mailing Address - Country:US
Mailing Address - Phone:732-818-1999
Mailing Address - Fax:732-286-2226
Practice Address - Street 1:89 RIVERWOOD DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-1292
Practice Address - Country:US
Practice Address - Phone:732-818-1999
Practice Address - Fax:732-286-2226
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00557200111N00000X
NC2250111N00000X
SC1927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ035431Medicare ID - Type UnspecifiedMEDICARE
NJU59064Medicare UPIN