Provider Demographics
NPI:1003928508
Name:KOVACIK, THOMAS MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:KOVACIK
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 1:1128 MONROE STREET
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-2542
Mailing Address - Country:US
Mailing Address - Phone:309-342-9147
Mailing Address - Fax:309-342-9147
Practice Address - Street 1:1128 MONROE STREET
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2542
Practice Address - Country:US
Practice Address - Phone:309-342-9147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
04832003OtherBLUE CROSS BLUE SHIELD
04832003OtherBLUE CROSS BLUE SHIELD
428690Medicare ID - Type Unspecified
L87678Medicare ID - Type Unspecified