Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 21822 | CA |
N | 111NN0400X | Neurology | 21822 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 21822 | CA |
NPI | 1659361350 |
---|---|
Provider Name | Dr. Kenneth A Thomas |
First Address | Pacifica, CA 94044-2652 |
Second Address | Pacifica, CA 94044-2652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U38642 | (02) | CA |