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General NPI Number Information
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NPI Number | 1508706284
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Entity Type | Individual
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Provider Name | DAMON THOMAS
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Gender | Male
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 300 W HICKORY ST RM 5
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City | APPLE RIVER
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State | IL
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Zip | 61001-9455
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Country | US
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Telephone | 779-431-8713
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Fax |
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Provider Business Mailing Address
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Address Line | 1981 SANTA MONICA DR
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City | ROCKFORD
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State | IL
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Zip | 61108-6728
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Country | US
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Telephone |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 203255
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227012538
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License Number State | IL
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