=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295104214
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTOPHER THOMA DC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2015
-----------------------------------------------------
Last Update Date | 02/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 OZARK TRAIL DR STE 105
-----------------------------------------------------
City | ELLISVILLE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63011-2156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-207-6600
-----------------------------------------------------
Fax | 636-207-6631
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1700 TIMBER RIDGE ESTATES DR
-----------------------------------------------------
City | WILDWOOD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63011-1974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-888-1708
-----------------------------------------------------
Fax | 636-391-0437
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHAIRMAN
-----------------------------------------------------
Name | DR. CHRISTOPHER FRANKLIN THOMA
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 660-888-1708
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2015031532
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------