Provider Demographics
NPI:1063568616
Name:THOMAS, WILLIAM R JR (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:THOMAS
Suffix:JR
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 1:725 DESERT FLOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1078
Mailing Address - Country:US
Mailing Address - Phone:719-542-3131
Mailing Address - Fax:719-542-7437
Practice Address - Street 1:725 DESERT FLOWER BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001
Practice Address - Country:US
Practice Address - Phone:719-542-3131
Practice Address - Fax:719-542-7437
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U02278Medicare UPIN
CO23353Medicare ID - Type Unspecified