MEDICARE: MR. THOMAS EDWARD SONTAG D.C., B.S.

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	0104556692	VA

General Provider Information

NPI Number	:	1841527090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS EDWARD SONTAG D.C., B.S.

Provider Business Mailing Address
First Line	:	3507 BOULEVARD
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1319
Country	:	US
Telephone Number	:	804-526-7125
Fax Number	:	804-520-7624

Provider Business Practice Location Address
First Line	:	3507 BOULEVARD
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1319
Country	:	US
Telephone Number	:	804-526-7125
Fax Number	:	804-520-7624

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

Provider Enumeration Date	:	11/09/2009
Last Update Date	:	11/09/2009

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