Provider Demographics
NPI:1841342599
Name:POWER, THOMAS RAYMOND (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RAYMOND
Last Name:POWER
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 1:19015 BUSHARD ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-2431
Mailing Address - Country:US
Mailing Address - Phone:714-965-5350
Mailing Address - Fax:714-965-5348
Practice Address - Street 1:19015 BUSHARD ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-2431
Practice Address - Country:US
Practice Address - Phone:714-965-5350
Practice Address - Fax:714-965-5348
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22127111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU60643Medicare UPIN