Provider Demographics
NPI:1841556529
Name:TOMCZAK, KATY MARGARET (DC)
Entity Type:Individual
Prefix:DR
First Name:KATY
Middle Name:MARGARET
Last Name:TOMCZAK
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 1:3701 DURAND AVE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-4458
Mailing Address - Country:US
Mailing Address - Phone:262-554-5458
Mailing Address - Fax:262-554-7465
Practice Address - Street 1:3701 DURAND AVE
Practice Address - Street 2:SUITE 145
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-4458
Practice Address - Country:US
Practice Address - Phone:262-554-5458
Practice Address - Fax:262-554-7465
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4877-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor