=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760576805
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS JOHN DRAG II D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 12/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1531 ROUTE 82
-----------------------------------------------------
City | HOPEWELL JUNCTION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12533-3304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-223-8511
-----------------------------------------------------
Fax | 845-223-8272
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 822 ROUTE 82 SUITE 2
-----------------------------------------------------
City | HOPEWELL JUNCTION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12533-3304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-223-8511
-----------------------------------------------------
Fax | 845-223-8272
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X010558
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------