Provider Demographics
NPI:1316959117
Name:AXELSON, THOMAS J (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:AXELSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:J
Other - Last Name:AXELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:901 NEWMAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5252
Mailing Address - Country:US
Mailing Address - Phone:252-633-3334
Mailing Address - Fax:252-637-4483
Practice Address - Street 1:901 NEWMAN RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5252
Practice Address - Country:US
Practice Address - Phone:252-633-3334
Practice Address - Fax:252-637-4483
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC350046002OtherRAILROAD MEDICARE
NC890833FTMedicaid
NC890833GMedicaid
NC0833GOtherBCBS PROVIDER NUMBER
NC0833GOtherBCBS PROVIDER NUMBER
NC2452249Medicare ID - Type Unspecified
NC890833FTMedicaid