Provider Demographics
NPI:1750357497
Name:O'NEILL, THOMAS DANIEL (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DANIEL
Last Name:O'NEILL
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 1:1617 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2422
Mailing Address - Country:US
Mailing Address - Phone:208-664-5000
Mailing Address - Fax:208-667-8098
Practice Address - Street 1:1617 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2422
Practice Address - Country:US
Practice Address - Phone:208-664-5000
Practice Address - Fax:208-667-8098
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC4694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID31546OtherREGENCE BLUE SHIELD OF ID
IDC4694OtherBLUE CROSS OF IDAHO
IDT44485Medicare UPIN
ID31546OtherREGENCE BLUE SHIELD OF ID