Provider Demographics
NPI:1033419130
Name:L. ANDREW TOLK, DC
Entity Type:Organization
Organization Name:L. ANDREW TOLK, DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:L. ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-651-3521
Mailing Address - Street 1:102 HOPMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06089
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 HOPMEADOW ST
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06089
Practice Address - Country:US
Practice Address - Phone:860-651-3521
Practice Address - Fax:860-651-6149
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
CT302111N00000X
CT001705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty