MEDICARE: THOMAS KOLENKO DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	11769	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TXB139828	OTHER	TX	MEDICARE ID

General Provider Information

NPI Number	:	1184911364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS KOLENKO DC

Provider Business Mailing Address
First Line	:	19875 SOUTHWEST FWY STE 100
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-3502
Country	:	US
Telephone Number	:	832-886-0385
Fax Number	:	281-254-7892

Provider Business Practice Location Address
First Line	:	19875 SOUTHWEST FWY STE 100
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-3502
Country	:	US
Telephone Number	:	832-886-0385
Fax Number	:	281-254-7892

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	12/07/2020

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Directions to “ THOMAS KOLENKO DC” Practice Location

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