Provider Demographics
NPI:1649336207
Name:MENENDEZ, THOMAS ALLAN (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALLAN
Last Name:MENENDEZ
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 1:101 HERITAGE SQ
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-1863
Mailing Address - Country:US
Mailing Address - Phone:812-246-2225
Mailing Address - Fax:
Practice Address - Street 1:101 HERITAGE SQ
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1863
Practice Address - Country:US
Practice Address - Phone:812-246-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001272A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100384510Medicaid
IN000000256243OtherANTHEM BCBS
IN000000075222OtherANTHEM BCBS
IN000000075222OtherANTHEM BCBS
IN000000256243OtherANTHEM BCBS
IN350050942Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IN100384510Medicaid