Provider Demographics
NPI:1891962767
Name:THOMAS, TREVOR E (DC)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:E
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:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:SUGARCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44681-0446
Mailing Address - Country:US
Mailing Address - Phone:330-852-3032
Mailing Address - Fax:330-852-5012
Practice Address - Street 1:110 ANDREAS DR NE STE B
Practice Address - Street 2:
Practice Address - City:SUGARCREEK
Practice Address - State:OH
Practice Address - Zip Code:44681-7503
Practice Address - Country:US
Practice Address - Phone:330-852-3032
Practice Address - Fax:330-852-5012
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH128800Medicare PIN