Provider Demographics
NPI:1245452754
Name:FRAUENHOFER, THOMAS FORBES SR (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:FORBES
Last Name:FRAUENHOFER
Suffix:SR
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 1:2025 W EAU GALLIE BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4085
Mailing Address - Country:US
Mailing Address - Phone:321-255-1509
Mailing Address - Fax:321-259-0117
Practice Address - Street 1:2025 W EAU GALLIE BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4085
Practice Address - Country:US
Practice Address - Phone:321-255-1509
Practice Address - Fax:321-259-0117
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor