Provider Demographics
NPI:1205909660
Name:THOMAS, TIMOTHY MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:THOMAS
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 1:15173 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2637
Mailing Address - Country:US
Mailing Address - Phone:734-284-8600
Mailing Address - Fax:734-284-6209
Practice Address - Street 1:15173 EUREKA RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2637
Practice Address - Country:US
Practice Address - Phone:734-284-8600
Practice Address - Fax:734-284-6209
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H25022OtherBLUE CROSS BS OF MI
0H25022Medicare ID - Type Unspecified
MI950H25022OtherBLUE CROSS BS OF MI