MEDICARE: DR. THOMAS DAVID UNDERHILL 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	1242	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	71069775950	OTHER	AR	QUAL CHOICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	653126	OTHER	AR	UNITED HEALTH CARE
4	7366212	OTHER	AR	AETNA

General Provider Information

NPI Number	:	1265584296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS DAVID UNDERHILL D.C.

Provider Business Mailing Address
First Line	:	PO BOX 600
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72811-0600
Country	:	US
Telephone Number	:	479-967-4030
Fax Number	:	479-967-3713

Provider Business Practice Location Address
First Line	:	2803 W MAIN ST
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72801-2470
Country	:	US
Telephone Number	:	479-967-4030
Fax Number	:	479-967-3713

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	03/13/2014

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