Provider Demographics
NPI:1285792424
Name:HENNESSEY, THOMAS JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAMES
Last Name:HENNESSEY
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 1:515 S SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-5037
Mailing Address - Country:US
Mailing Address - Phone:804-733-8377
Mailing Address - Fax:804-733-8459
Practice Address - Street 1:515 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5037
Practice Address - Country:US
Practice Address - Phone:804-733-8377
Practice Address - Fax:804-733-8459
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1285792424OtherNPI NUMBER
VA1285792424OtherNPI NUMBER