MEDICARE: THOMAS WILLIAM MUNDORF D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC-005725-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC-005725-L	OTHER	PA	111N00000X
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083820708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS WILLIAM MUNDORF D.C.

Provider Business Mailing Address
First Line	:	32 N MOUNTAIN BLVD
Second Line	:
City	:	MOUNTAIN TOP
State	:	PA
Zip	:	18707-1117
Country	:	US
Telephone Number	:	570-474-2929
Fax Number	:

Provider Business Practice Location Address
First Line	:	32 N MOUNTAIN BLVD
Second Line	:
City	:	MOUNTAIN TOP
State	:	PA
Zip	:	18707-1117
Country	:	US
Telephone Number	:	570-474-2929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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