Provider Demographics
NPI:1902011323
Name:MICELI, THOMAS FRANK (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:FRANK
Last Name:MICELI
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 1:33 LEEDS BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1147
Mailing Address - Country:US
Mailing Address - Phone:631-696-2225
Mailing Address - Fax:
Practice Address - Street 1:33 LEEDS BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1147
Practice Address - Country:US
Practice Address - Phone:631-696-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002908-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor