Provider Demographics
NPI:1598950982
Name:MONUMENT CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MONUMENT CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:TOMOI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-632-2255
Mailing Address - Street 1:713 W 27TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4412
Mailing Address - Country:US
Mailing Address - Phone:308-632-2255
Mailing Address - Fax:308-632-2328
Practice Address - Street 1:713 W 27TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4412
Practice Address - Country:US
Practice Address - Phone:308-632-2255
Practice Address - Fax:308-632-2328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========04Medicaid
NE=========04Medicaid