MEDICARE: THOMAS CHIROPRACTIC

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	08002580A	IN

General Provider Information

NPI Number	:	1831475755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS CHIROPRACTIC

Provider Business Mailing Address
First Line	:	3162 MALLARD COVE LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-2882
Country	:	US
Telephone Number	:	260-267-9052
Fax Number	:	260-267-9062

Provider Business Practice Location Address
First Line	:	3162 MALLARD COVE LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-2882
Country	:	US
Telephone Number	:	260-267-9052
Fax Number	:	260-267-9062

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. SEAN THOMAS
Credential	:	D.C.
Telephone Number	:	260-267-9052

Provider Enumeration Date	:	10/24/2011
Last Update Date	:	10/24/2011

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