Provider Demographics
NPI:1245315506
Name:MCNULTY, THOMAS SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SCOTT
Last Name:MCNULTY
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 1:210 SKOKIE VALLEY RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4464
Mailing Address - Country:US
Mailing Address - Phone:847-831-5252
Mailing Address - Fax:
Practice Address - Street 1:210 SKOKIE VALLEY RD
Practice Address - Street 2:SUITE 7
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4464
Practice Address - Country:US
Practice Address - Phone:847-831-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL049-05536OtherBC/BS PROVIDER NUMBER
IL049-05536OtherBC/BS PROVIDER NUMBER
IL388660Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER