MEDICARE: DR. TOM HIBBARD 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	32191	CA

General Provider Information

NPI Number	:	1528330578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOM HIBBARD D.C.

Provider Business Mailing Address
First Line	:	99 LONG CT
Second Line	:	SUITE 102
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-6066
Country	:	US
Telephone Number	:	805-409-7071
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 LONG CT
Second Line	:	SUITE 102
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-6066
Country	:	US
Telephone Number	:	805-409-7071
Fax Number	:

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

Provider Enumeration Date	:	02/07/2012
Last Update Date	:	02/07/2012

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