Provider Demographics
NPI:1790173920
Name:THOMAS, DAVID CLAYTON (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CLAYTON
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:JAMES
Other - Last Name:KOWALUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2030 W BASELINE RD
Mailing Address - Street 2:STE 182
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-6574
Mailing Address - Country:US
Mailing Address - Phone:415-841-3175
Mailing Address - Fax:
Practice Address - Street 1:9744 W NORTHERN AVE
Practice Address - Street 2:STE 1355
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-4603
Practice Address - Country:US
Practice Address - Phone:623-806-1255
Practice Address - Fax:480-223-1194
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor