Provider Demographics
NPI:1730227257
Name:DEVRIES, THOMAS MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:DEVRIES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 JOHN YOUNG WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2567
Mailing Address - Country:US
Mailing Address - Phone:610-280-0987
Mailing Address - Fax:610-280-0991
Practice Address - Street 1:491 JOHN YOUNG WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2567
Practice Address - Country:US
Practice Address - Phone:610-280-0987
Practice Address - Fax:610-280-0991
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006673L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU93691Medicare UPIN
PA066700Medicare ID - Type Unspecified