Provider Demographics
NPI:1265584296
Name:UNDERHILL, THOMAS DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DAVID
Last Name:UNDERHILL
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:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-0600
Mailing Address - Country:US
Mailing Address - Phone:479-967-4030
Mailing Address - Fax:479-967-3713
Practice Address - Street 1:2803 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2470
Practice Address - Country:US
Practice Address - Phone:479-967-4030
Practice Address - Fax:479-967-3713
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR71069775950OtherQUAL CHOICE
AR134606718Medicaid
AR653126OtherUNITED HEALTH CARE
AR7366212OtherAETNA
AR653126OtherUNITED HEALTH CARE
AR7366212OtherAETNA