MEDICARE: DR. THOMAS PAUL ZWART 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	111NS0005X	Sports Physician Chiropractor	X06006-3	NY

General Provider Information

NPI Number	:	1487614657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS PAUL ZWART D.C.

Provider Business Mailing Address
First Line	:	PO BOX 149
Second Line	:
City	:	PINE BUSH
State	:	NY
Zip	:	12566
Country	:	US
Telephone Number	:	845-744-2420
Fax Number	:	845-744-2429

Provider Business Practice Location Address
First Line	:	103 MAPLE AVE
Second Line	:
City	:	PINE BUSH
State	:	NY
Zip	:	12566-7120
Country	:	US
Telephone Number	:	845-744-2420
Fax Number	:	845-744-2429

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	05/24/2011

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