Provider Demographics
NPI:1184760340
Name:MAURNO, THOMAS R (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:MAURNO
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 1:5901 SW 74TH ST
Mailing Address - Street 2:SUITE209
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5165
Mailing Address - Country:US
Mailing Address - Phone:305-666-4449
Mailing Address - Fax:305-666-4749
Practice Address - Street 1:5901 SW 74TH ST
Practice Address - Street 2:SUITE209
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5165
Practice Address - Country:US
Practice Address - Phone:305-666-4449
Practice Address - Fax:305-666-4749
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007476111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036696OtherNEIGHBORHOOD HEALTH PLAN
FL55636OtherBLUE CROSS BLUE SHIELD
FL45257Medicare ID - Type UnspecifiedGROUP