Healthcare Provider Details

I. General information

NPI: 1720080286
Provider Name (Legal Business Name): ALBERT EDWARD THOMAS III DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 CENTRAL CT
HERMITAGE TN
37076-3153
US

IV. Provider business mailing address

1307 CENTRAL CT
HERMITAGE TN
37076-3153
US

V. Phone/Fax

Practice location:
  • Phone: 615-678-8745
  • Fax: 615-818-0758
Mailing address:
  • Phone: 615-678-8745
  • Fax: 615-818-0758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC1457
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: