Provider Demographics
NPI:1215937123
Name:HALWAX, THOMAS MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:HALWAX
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 1:15348 RIDGELAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1619
Mailing Address - Country:US
Mailing Address - Phone:708-687-2724
Mailing Address - Fax:
Practice Address - Street 1:15348 RIDGELAND AVE
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-1619
Practice Address - Country:US
Practice Address - Phone:708-687-2724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2012-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0380005233111N00000X
FL4745111N00000X
IN08000995111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT39039Medicare UPIN
IL782200Medicare ID - Type UnspecifiedMEDICARE ID