MEDICARE: DR. THOMAS WILLIAM LEGROW 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	1958	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08513	OTHER	NC	BCBS PROVIDER #

General Provider Information

NPI Number	:	1619031200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS WILLIAM LEGROW D.C.

Provider Business Mailing Address
First Line	:	400 CRUTCHFIELD ST
Second Line	:	SUITE D
City	:	DURHAM
State	:	NC
Zip	:	27704-2771
Country	:	US
Telephone Number	:	919-620-7900
Fax Number	:	919-479-5061

Provider Business Practice Location Address
First Line	:	400 CRUTCHFIELD ST
Second Line	:	SUITE D
City	:	DURHAM
State	:	NC
Zip	:	27704-2771
Country	:	US
Telephone Number	:	919-620-7900
Fax Number	:	919-479-5061

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	01/27/2009

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