Provider Demographics
NPI:1366742314
Name:TOMCZAK CHIROPRACTIC OFFICE LLC
Entity type:Organization
Organization Name:TOMCZAK CHIROPRACTIC OFFICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:TOMCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-679-1910
Mailing Address - Street 1:PO BOX 741
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-0741
Mailing Address - Country:US
Mailing Address - Phone:262-679-1910
Mailing Address - Fax:262-679-9098
Practice Address - Street 1:S75W17475 JANESVILLE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-9378
Practice Address - Country:US
Practice Address - Phone:262-679-1910
Practice Address - Fax:262-679-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4372-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty