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General NPI Number Information
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NPI Number | 1366742314
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Entity Type | Organization
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Legal Business Name | TOMCZAK CHIROPRACTIC OFFICE LLC
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Dates
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Enumeration Date | 10/25/2010
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Last Update Date | 10/25/2010
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Provider Practice Location Address
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Address Line | S75W17475 JANESVILLE RD
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City | MUSKEGO
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State | WI
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Zip | 53150-9378
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Country | US
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Telephone | 262-679-1910
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Fax | 262-679-9098
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Provider Business Mailing Address
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Address Line | PO BOX 741
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City | MUSKEGO
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State | WI
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Zip | 53150-0741
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Country | US
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Telephone | 262-679-1910
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Fax | 262-679-9098
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. CHRISTOPHER LEWIS TOMCZAK
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Credential | D.C.
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Telephone | 262-679-1910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4372-012
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License Number State | WI
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