Healthcare Provider Details

I. General information

NPI: 1194004200
Provider Name (Legal Business Name): THOMAS DORN L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2011
Last Update Date: 01/09/2021
Certification Date: 01/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EAGLE RD STE 30
WAYNE PA
19087-3115
US

IV. Provider business mailing address

926 SELMA ST
NORRISTOWN PA
19401-3634
US

V. Phone/Fax

Practice location:
  • Phone: 215-680-6532
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAK000995
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: