Provider Demographics
NPI:1831236082
Name:THOMAS, ROBERT (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
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 1:30 WINCHESTER CANYON RD
Mailing Address - Street 2:139
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-1960
Mailing Address - Country:US
Mailing Address - Phone:805-708-0823
Mailing Address - Fax:
Practice Address - Street 1:510 N MILPAS ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-3137
Practice Address - Country:US
Practice Address - Phone:805-708-0823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26155111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26155OtherLICENSE
CAV06956Medicare UPIN
CADC26155OtherLICENSE