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General NPI Number Information
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NPI Number | 1477797819
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Entity Type | Organization
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Legal Business Name | MICHAEL ERIC TOM DC, P.A.
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Dates
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Enumeration Date | 04/29/2009
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Last Update Date | 04/29/2009
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Provider Practice Location Address
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Address Line | 1320 N MAIN ST
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City | KISSIMMEE
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State | FL
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Zip | 34744-4289
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Country | US
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Telephone | 407-933-7246
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Fax | 407-933-0220
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Provider Business Mailing Address
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Address Line | 1320 N MAIN ST
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City | KISSIMMEE
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State | FL
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Zip | 34744-4289
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Country | US
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Telephone | 407-933-7246
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Fax | 407-933-0220
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Authorized Official
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Title or Position | TREATING PHYSICIAN / PRESIDENT
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Name | DR. MICHAEL ERIC TOM
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Credential | D.C.
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Telephone | 407-933-7246
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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 | CH 8768
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License Number State | FL
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