MEDICARE: DR. THOMAS O POPOW 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	3019	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	085RT	OTHER	NC	BC/BS PROVIDER NUMBER

General Provider Information

NPI Number	:	1457397887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS O POPOW D.C.

Provider Business Mailing Address
First Line	:	216 CROSSFIRE RD
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-8560
Country	:	US
Telephone Number	:	919-577-3974
Fax Number	:	919-577-6351

Provider Business Practice Location Address
First Line	:	1100 HOLLY SPRINGS RD
Second Line	:	SUITE 100
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-9469
Country	:	US
Telephone Number	:	919-577-3974
Fax Number	:	919-577-6351

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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