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General NPI Number Information
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NPI Number | 1689450892
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Entity Type | Individual
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Provider Name | ANDRIC THOMAS D.C
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Gender | Male
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Dates
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Enumeration Date | 09/04/2023
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 266 DOGWOOD BLVD UNIT 5
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City | FLOWOOD
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State | MS
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Zip | 39232-8602
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Country | US
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Telephone | 601-391-6936
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Fax |
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Provider Business Mailing Address
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Address Line | 2945 LAYFAIR DR APT 417
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City | FLOWOOD
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State | MS
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Zip | 39232-9759
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Country | US
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Telephone | 662-931-5026
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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 | 1383
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 111NX0100X
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Taxonomy Name | Occupational Health Chiropractor
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License Number | 14676
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License Number State | FL
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