Provider Demographics
NPI:1942574256
Name:O'BRIEN, THOMAS (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:O'BRIEN
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 1:2500 N PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1905
Mailing Address - Country:US
Mailing Address - Phone:610-789-5555
Mailing Address - Fax:
Practice Address - Street 1:2500 N PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1905
Practice Address - Country:US
Practice Address - Phone:610-789-5555
Practice Address - Fax:484-452-6045
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor