Provider Demographics
NPI:1891852067
Name:BAKMAN, THOMAS STANLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:STANLEY
Last Name:BAKMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:NONE
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:18818 TELLER AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1678
Mailing Address - Country:US
Mailing Address - Phone:949-535-2322
Mailing Address - Fax:949-535-2330
Practice Address - Street 1:18818 TELLER AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1678
Practice Address - Country:US
Practice Address - Phone:949-535-2322
Practice Address - Fax:949-535-2330
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19041111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47-1674398OtherTAX ID
CA47-1674398OtherTAX ID