Provider Demographics
NPI:1710066501
Name:TOMAC, KATHERINE LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LYNN
Last Name:TOMAC
Suffix:
Gender:F
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:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:NC
Mailing Address - Zip Code:28124-0114
Mailing Address - Country:US
Mailing Address - Phone:704-436-2303
Mailing Address - Fax:704-436-2306
Practice Address - Street 1:217 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4763
Practice Address - Country:US
Practice Address - Phone:704-436-2303
Practice Address - Fax:704-436-2306
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908812Medicaid
NCU77247Medicare UPIN
NC8908812Medicaid