Provider Demographics
NPI:1891936274
Name:THOMAS, PAMELA JEAN (DC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 PINE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-4347
Mailing Address - Country:US
Mailing Address - Phone:781-934-0327
Mailing Address - Fax:
Practice Address - Street 1:144 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1712
Practice Address - Country:US
Practice Address - Phone:781-982-5566
Practice Address - Fax:781-982-5588
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36227Medicare PIN