Provider Demographics
NPI:1770756728
Name:BRESCIA, THOMAS RICHARD (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:RICHARD
Last Name:BRESCIA
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 1:17617 S FARRELL RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-9750
Mailing Address - Country:US
Mailing Address - Phone:773-842-9092
Mailing Address - Fax:
Practice Address - Street 1:16626 W 159TH ST STE 700
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-8019
Practice Address - Country:US
Practice Address - Phone:773-842-9092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor