Provider Demographics
NPI:1720165079
Name:SHERMAN, THOMAS RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RAY
Last Name:SHERMAN
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 1:1375 N CENTER POINT RD
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-1239
Mailing Address - Country:US
Mailing Address - Phone:319-393-3710
Mailing Address - Fax:319-294-8250
Practice Address - Street 1:1375 N CENTER POINT RD
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-1239
Practice Address - Country:US
Practice Address - Phone:319-393-3710
Practice Address - Fax:319-294-8250
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0013425Medicaid
IA0013425Medicaid
IAT00155Medicare UPIN