Provider Demographics
NPI:1942560990
Name:DR. THOMAS J. PALIC DC PC
Entity Type:Organization
Organization Name:DR. THOMAS J. PALIC DC PC
Other - Org Name:PALIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:PALIC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-766-7100
Mailing Address - Street 1:PO BOX 2812
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632
Mailing Address - Country:US
Mailing Address - Phone:970-766-7100
Mailing Address - Fax:970-766-7101
Practice Address - Street 1:210 EDWARDS VILLAGE BLVD
Practice Address - Street 2:UNIT A101
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632
Practice Address - Country:US
Practice Address - Phone:970-766-7100
Practice Address - Fax:970-766-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty