Provider Demographics
NPI:1770665895
Name:SIWA, THOMAS A (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:SIWA
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 1:5148 N 90TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-2830
Mailing Address - Country:US
Mailing Address - Phone:402-933-2273
Mailing Address - Fax:402-502-9255
Practice Address - Street 1:5148 N 90TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-2830
Practice Address - Country:US
Practice Address - Phone:402-933-2273
Practice Address - Fax:402-502-9255
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100250829-00Medicaid
NE612846OtherUNITED HEALTHCARE
NE99529OtherNEBRASKA BLUECROSS/BLUESH
NE612846OtherUNITED HEALTHCARE
NE100250829-00Medicaid