Provider Demographics
NPI:1992768154
Name:CLOSE, THOMAS HARLAND (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:HARLAND
Last Name:CLOSE
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 1:240 BEACON LITE RD
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9106
Mailing Address - Country:US
Mailing Address - Phone:719-481-3394
Mailing Address - Fax:719-481-3604
Practice Address - Street 1:240 BEACON LITE RD
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9106
Practice Address - Country:US
Practice Address - Phone:719-481-3394
Practice Address - Fax:719-481-3604
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor