Provider Demographics
NPI:1720087638
Name:STANZEL, THOMAS H (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:STANZEL
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 1:2050 TERRY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1896
Mailing Address - Country:US
Mailing Address - Phone:303-485-8877
Mailing Address - Fax:303-485-8790
Practice Address - Street 1:2050 TERRY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1896
Practice Address - Country:US
Practice Address - Phone:303-485-8877
Practice Address - Fax:303-485-8790
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
CO5219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO800217Medicare ID - Type Unspecified