Provider Demographics
NPI:1467531301
Name:KONOPKA, THOMAS JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:KONOPKA
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 1:200 BUTTERCUP CREEK BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3708
Mailing Address - Country:US
Mailing Address - Phone:512-249-8800
Mailing Address - Fax:512-249-0337
Practice Address - Street 1:200 BUTTERCUP CREEK BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3708
Practice Address - Country:US
Practice Address - Phone:512-249-8800
Practice Address - Fax:512-249-0337
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7021111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2306055825Medicaid
U63888Medicare UPIN
TX605582Medicare ID - Type Unspecified