Provider Demographics
NPI:1760576805
Name:DRAG, THOMAS JOHN II (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:DRAG
Suffix:II
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 1:822 ROUTE 82
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-3304
Mailing Address - Country:US
Mailing Address - Phone:845-223-8511
Mailing Address - Fax:845-223-8272
Practice Address - Street 1:1531 ROUTE 82
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-3304
Practice Address - Country:US
Practice Address - Phone:845-223-8511
Practice Address - Fax:845-223-8272
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC10558-7BOtherWORKERS COMPENSATION
NY02589444Medicaid
NYXYW021Medicare PIN
NYU94521Medicare UPIN
NY02589444Medicaid