Provider Demographics
NPI:1912901281
Name:LEBLANC, THOMAS C (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:LEBLANC
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 1:142 COTTAGE ST
Mailing Address - Street 2:1R
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3007
Mailing Address - Country:US
Mailing Address - Phone:401-721-9960
Mailing Address - Fax:401-721-9961
Practice Address - Street 1:142 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3007
Practice Address - Country:US
Practice Address - Phone:401-721-9960
Practice Address - Fax:401-721-9961
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45777Medicare ID - Type Unspecified