Provider Demographics
NPI:1972793008
Name:RIORDAN, THOMAS J (LIC AC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:RIORDAN
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MERCURY DR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-1933
Mailing Address - Country:US
Mailing Address - Phone:573-447-4180
Mailing Address - Fax:
Practice Address - Street 1:2024 CHERRY HILL DR
Practice Address - Street 2:SUITE 107
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5921
Practice Address - Country:US
Practice Address - Phone:573-447-4180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212575171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist