Provider Demographics
NPI:1528030566
Name:TRUJILLO, TONY THOMAS (DC)
Entity Type:Individual
Prefix:MR
First Name:TONY
Middle Name:THOMAS
Last Name:TRUJILLO
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 1:101 DENTISTA DR
Mailing Address - Street 2:STE K
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909
Mailing Address - Country:US
Mailing Address - Phone:501-922-0800
Mailing Address - Fax:501-922-0846
Practice Address - Street 1:101 DENTISTA DR
Practice Address - Street 2:STE K
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909
Practice Address - Country:US
Practice Address - Phone:501-922-0800
Practice Address - Fax:501-922-0846
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
5U950Medicare ID - Type Unspecified
T05407Medicare UPIN