Provider Demographics
NPI:1740490606
Name:HARVEY, THOMAS EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:HARVEY
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 1:421 N FREDERIC ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3235
Mailing Address - Country:US
Mailing Address - Phone:818-842-0525
Mailing Address - Fax:
Practice Address - Street 1:10730 RIVERSIDE DR
Practice Address - Street 2:SUITE A
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2313
Practice Address - Country:US
Practice Address - Phone:818-506-3040
Practice Address - Fax:818-506-3058
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24880111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24880Medicare ID - Type Unspecified