MEDICARE: DR. KENNETH A THOMAS 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	111NN0400X	Neurology Chiropractor	21822	CA
2	111N00000X	Chiropractor	21822	CA
3	111NS0005X	Sports Physician Chiropractor	21822	CA

General Provider Information

NPI Number	:	1659361350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH A THOMAS D.C.

Provider Business Mailing Address
First Line	:	320 EUREKA SQ
Second Line	:
City	:	PACIFICA
State	:	CA
Zip	:	94044-2652
Country	:	US
Telephone Number	:	650-738-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 EUREKA SQ
Second Line	:
City	:	PACIFICA
State	:	CA
Zip	:	94044-2652
Country	:	US
Telephone Number	:	650-738-2225
Fax Number	:

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	09/11/2025

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