Individual
THOMAS PAUL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D. C.
Contact information
Practice address
W177N9856 RIVERCREST DR, SUITE 102, GERMANTOWN, WI 53022-4647
(262) 251-9300
(262) 251-9303
Mailing address
1428 E RACINE AVE, WAUKESHA, WI 53186-6462
(262) 832-8888
(262) 806-0028
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
2664
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200879361018
BLUE CROSS BLUE SHIELD
WI
01
—
P00110391
RAILROAD MEDICARE
WI
Enumeration date
04/14/2006
Last updated
10/29/2019
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