Healthcare Provider Details

I. General information

NPI: 1881658045
Provider Name (Legal Business Name): THOMAS PAUL SMITH D. C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W177N9856 RIVERCREST DR SUITE 102
GERMANTOWN WI
53022-4647
US

IV. Provider business mailing address

1428 E RACINE AVE
WAUKESHA WI
53186-6462
US

V. Phone/Fax

Practice location:
  • Phone: 262-251-9300
  • Fax: 262-251-9303
Mailing address:
  • Phone: 262-832-8888
  • Fax: 262-806-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2664
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: