MEDICARE: DR. ALEXANDER THOMAS JR. D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4166	SC

General Provider Information

NPI Number	:	1053862656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER THOMAS JR. D.C.

Provider Business Mailing Address
First Line	:	9325 BLUE HOUSE RD
Second Line	:	APT 7305
City	:	LADSON
State	:	SC
Zip	:	29456-4201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	464 AZALEA SQUARE BLVD UNIT D
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-7335
Country	:	US
Telephone Number	:	843-547-2152
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2016
Last Update Date	:	10/18/2016

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