Provider Demographics
NPI:1457397887
Name:POPOW, THOMAS O (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:O
Last Name:POPOW
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 1:216 CROSSFIRE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-8560
Mailing Address - Country:US
Mailing Address - Phone:919-577-3974
Mailing Address - Fax:919-577-6351
Practice Address - Street 1:1100 HOLLY SPRINGS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9469
Practice Address - Country:US
Practice Address - Phone:919-577-3974
Practice Address - Fax:919-577-6351
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085RTOtherBC/BS PROVIDER NUMBER
NC085RTOtherBC/BS PROVIDER NUMBER
NCU68425Medicare UPIN