Provider Demographics
NPI:1699896134
Name:NORBERG, THOMAS R (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:NORBERG
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 1:14 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1664
Mailing Address - Country:US
Mailing Address - Phone:815-485-0990
Mailing Address - Fax:
Practice Address - Street 1:19135 LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-9346
Practice Address - Country:US
Practice Address - Phone:708-479-3456
Practice Address - Fax:708-479-4021
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL710531Medicare ID - Type Unspecified