Provider Demographics
NPI:1437397593
Name:DWORAK, TY THOMAS (DC)
Entity type:Individual
Prefix:
First Name:TY
Middle Name:THOMAS
Last Name:DWORAK
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 1:1517 E 42ND ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-2685
Mailing Address - Country:US
Mailing Address - Phone:314-973-5626
Mailing Address - Fax:
Practice Address - Street 1:218 W 39TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2802
Practice Address - Country:US
Practice Address - Phone:308-236-6499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor