Healthcare Provider Details

I. General information

NPI: 1629515036
Provider Name (Legal Business Name): THOMAS ROBERT SURNOCK D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 OCEAN VIEW BLVD STE 3
GLENDALE CA
91208-3417
US

IV. Provider business mailing address

3600 OCEAN VIEW BLVD STE 3
GLENDALE CA
91208-3417
US

V. Phone/Fax

Practice location:
  • Phone: 818-330-9669
  • Fax: 818-330-9668
Mailing address:
  • Phone: 818-330-9669
  • Fax: 818-330-9668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC33382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: