Provider Demographics
NPI:1619075934
Name:GARZILLO, THOMAS A (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:GARZILLO
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 1:1130 E PARKER RD STE 203
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5375
Mailing Address - Country:US
Mailing Address - Phone:972-422-2273
Mailing Address - Fax:972-881-3844
Practice Address - Street 1:1130 E PARKER RD STE 203
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5375
Practice Address - Country:US
Practice Address - Phone:972-422-2273
Practice Address - Fax:972-881-3844
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601665Medicare ID - Type Unspecified