Provider Demographics
NPI:1013986678
Name:TUMBARELLO, THOMAS (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:TUMBARELLO
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 1:700 SANDY PLAINS RD
Mailing Address - Street 2:STE A 8
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6370
Mailing Address - Country:US
Mailing Address - Phone:678-355-9090
Mailing Address - Fax:
Practice Address - Street 1:700 SANDY PLAINS RD
Practice Address - Street 2:STE A 8
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-6370
Practice Address - Country:US
Practice Address - Phone:678-355-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCJBCMedicare PIN