Provider Demographics
NPI:1740265859
Name:THOMAS, ROBERT P (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:THOMAS
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 1:2291 WATER ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-2484
Mailing Address - Country:US
Mailing Address - Phone:810-985-8770
Mailing Address - Fax:810-985-3248
Practice Address - Street 1:2291 WATER ST
Practice Address - Street 2:SUITE 7
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-2484
Practice Address - Country:US
Practice Address - Phone:810-985-8770
Practice Address - Fax:810-985-3248
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRT005300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950G45002OtherBLUE CROSS PROVIDER ID
MIT33568Medicare UPIN
MI0G45002Medicare ID - Type Unspecified