MEDICARE: THOMAS R LIGHTNER

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	DC295770	CA

General Provider Information

NPI Number	:	1881831162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS R LIGHTNER

Provider Business Mailing Address
First Line	:	1301 BROADWAY
Second Line	:	STE 11
City	:	MILLBRAE
State	:	CA
Zip	:	94030-1336
Country	:	US
Telephone Number	:	650-583-3813
Fax Number	:	650-583-6695

Provider Business Practice Location Address
First Line	:	1301 BROADWAY
Second Line	:	STE 11
City	:	MILLBRAE
State	:	CA
Zip	:	94030-1336
Country	:	US
Telephone Number	:	650-583-3813
Fax Number	:	650-583-6695

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THOMAS R LIGHTNER
Credential	:	DC
Telephone Number	:	650-583-3813

Provider Enumeration Date	:	01/08/2009
Last Update Date	:	01/08/2009

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Directions to “THOMAS R LIGHTNER ” Practice Location

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