Thomas W Gustafson, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

38MC00554200 Issued in NJ

Practice address

81 State Route 34 S
Suite C
Colts Neck, NJ 07722-1783

Phone

(732) 683-0200

Fax

(732) 683-1004

NPI assigned

Apr 3, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274140800000",
    "number": "1174644363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 STATE ROUTE 34 S",
            "address_2": "SUITE C",
            "city": "COLTS NECK",
            "state": "NJ",
            "postal_code": "077221783",
            "telephone_number": "732-683-0200",
            "fax_number": "732-683-1004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "81 STATE ROUTE 34 S",
            "address_2": "SUITE C",
            "city": "COLTS NECK",
            "state": "NJ",
            "postal_code": "077221783",
            "telephone_number": "732-683-0200",
            "fax_number": "732-683-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "THOMAS",
        "middle_name": "W",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2010-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00554200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENTIFICATON NUMBER",
            "identifier": "223746483",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Providers in Colts Neck, NJ by specialty
• Chiropractor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.