Provider Demographics
NPI:1851310460
Name:THOMAS, GREGORY SHANE (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:SHANE
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 1:152 THIERMAN LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-5010
Mailing Address - Country:US
Mailing Address - Phone:502-891-0333
Mailing Address - Fax:502-721-0086
Practice Address - Street 1:152 THIERMAN LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5010
Practice Address - Country:US
Practice Address - Phone:502-891-0333
Practice Address - Fax:502-721-0086
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6104802Medicare ID - Type Unspecified
KYV08554Medicare UPIN