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General NPI Number Information
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NPI Number | 1043450653
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Entity Type | Individual
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Provider Name | JACK THOMAS LI D.C.
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Gender | Male
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Dates
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Enumeration Date | 02/23/2009
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Last Update Date | 02/23/2009
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Provider Practice Location Address
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Address Line | 12340 SANTA MONICA BLVD SUITE 130
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City | LOS ANGELES
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State | CA
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Zip | 90025-2500
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Country | US
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Telephone | 310-207-1007
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Fax |
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Provider Business Mailing Address
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Address Line | 12340 SANTA MONICA BLVD SUITE 130
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City | LOS ANGELES
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State | CA
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Zip | 90025-2500
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Country | US
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Telephone | 310-207-1007
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC 31142
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License Number State | CA
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