Provider Demographics
NPI:1780048082
Name:CATHELL, THOMAS JACOB (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JACOB
Last Name:CATHELL
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 1:20915 ASHBURN RD STE 235
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5678
Mailing Address - Country:US
Mailing Address - Phone:724-882-5321
Mailing Address - Fax:
Practice Address - Street 1:20915 ASHBURN RD STE 235
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5678
Practice Address - Country:US
Practice Address - Phone:724-882-5321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011147111N00000X
VA0104557343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor