Provider Demographics
NPI:1851717029
Name:BOMBERY, THOMAS (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BOMBERY
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 1:122 CANAL ST. STE 109
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4015
Mailing Address - Country:US
Mailing Address - Phone:908-910-5880
Mailing Address - Fax:
Practice Address - Street 1:122 CANAL ST
Practice Address - Street 2:STE 109
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4015
Practice Address - Country:US
Practice Address - Phone:908-910-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor