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General NPI Number Information
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NPI Number | 1114085925
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Entity Type | Individual
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Provider Name | THOMAS LAWRENCE WHEATLEY D.C
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2380 S EOLA RD SUITE 104
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City | AURORA
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State | IL
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Zip | 60503-6489
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Country | US
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Telephone | 630-820-1700
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Fax | 630-820-0790
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Provider Business Mailing Address
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Address Line | 1761 PONTARELLI CT
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City | AURORA
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State | IL
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Zip | 60504-5300
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Country | US
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Telephone | 630-236-8718
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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 | 38009693
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License Number State | IL
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