Provider Demographics
NPI:1750327524
Name:KONICKI, THOMAS ANDREW (DC, DABCO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANDREW
Last Name:KONICKI
Suffix:
Gender:M
Credentials:DC, DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3814
Mailing Address - Country:US
Mailing Address - Phone:937-439-5400
Mailing Address - Fax:937-439-5420
Practice Address - Street 1:2165 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3814
Practice Address - Country:US
Practice Address - Phone:937-439-5400
Practice Address - Fax:937-439-5420
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1189111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU72502Medicare UPIN