Provider Demographics
NPI:1699861120
Name:OUELLETTE, THOMAS LAWRENCE (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LAWRENCE
Last Name:OUELLETTE
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 1:2900 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1718
Mailing Address - Country:US
Mailing Address - Phone:716-923-4375
Mailing Address - Fax:716-923-4379
Practice Address - Street 1:2900 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1718
Practice Address - Country:US
Practice Address - Phone:716-923-4375
Practice Address - Fax:716-923-4379
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009148-1111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC09148-0BOtherWORKERS COMPENSATION
NCRA6921Medicare ID - Type Unspecified
NYV05372Medicare UPIN