Provider Demographics
NPI:1386618288
Name:FORDIANI, THOMAS ROBERT (DC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ROBERT
Last Name:FORDIANI
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 1:30201 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2282
Mailing Address - Country:US
Mailing Address - Phone:248-585-0399
Mailing Address - Fax:248-585-4203
Practice Address - Street 1:30201 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2282
Practice Address - Country:US
Practice Address - Phone:248-585-0399
Practice Address - Fax:248-585-4203
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
78587Medicare UPIN
OM93610Medicare ID - Type Unspecified