Provider Demographics
NPI:1265406771
Name:KRICZKY, THOMAS ALAN (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALAN
Last Name:KRICZKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 S SUMNEYTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-2440
Mailing Address - Country:US
Mailing Address - Phone:215-661-8600
Mailing Address - Fax:215-699-3500
Practice Address - Street 1:631 S SUMNEYTOWN PIKE
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-2440
Practice Address - Country:US
Practice Address - Phone:215-661-8600
Practice Address - Fax:215-699-3500
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC0049112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA713328Medicare ID - Type Unspecified
PAU37256Medicare UPIN