Provider Demographics
NPI:1881376465
Name:100 CHIROPRACTIC THOMAS APC
Entity type:Organization
Organization Name:100 CHIROPRACTIC THOMAS APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STONE
Authorized Official - Middle Name:DYLAN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-996-7166
Mailing Address - Street 1:1835 NEWPORT BLVD STE D263
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-5013
Mailing Address - Country:US
Mailing Address - Phone:949-996-7166
Mailing Address - Fax:
Practice Address - Street 1:1835 NEWPORT BLVD STE D-26310
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-5031
Practice Address - Country:US
Practice Address - Phone:949-205-9265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty