Provider Demographics
NPI:1528353497
Name:ENTWISTLE, THOMAS PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PATRICK
Last Name:ENTWISTLE
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 1:1611 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-3304
Mailing Address - Country:US
Mailing Address - Phone:407-344-4878
Mailing Address - Fax:407-344-7878
Practice Address - Street 1:1611 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3304
Practice Address - Country:US
Practice Address - Phone:407-344-4878
Practice Address - Fax:407-344-7878
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-18
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor