Provider Demographics
NPI:1881831162
Name:THOMAS R LIGHTNER
Entity type:Organization
Organization Name:THOMAS R LIGHTNER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:LIGHTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-583-3813
Mailing Address - Street 1:1301 BROADWAY
Mailing Address - Street 2:STE 11
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1336
Mailing Address - Country:US
Mailing Address - Phone:650-583-3813
Mailing Address - Fax:650-583-6695
Practice Address - Street 1:1301 BROADWAY
Practice Address - Street 2:STE 11
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-1336
Practice Address - Country:US
Practice Address - Phone:650-583-3813
Practice Address - Fax:650-583-6695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC295770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0295770Medicare PIN