Provider Demographics
NPI:1265587125
Name:TOMCEK, LEONARD J (DC)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:J
Last Name:TOMCEK
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 1:320 ROSS AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-1816
Mailing Address - Country:US
Mailing Address - Phone:715-359-0229
Mailing Address - Fax:
Practice Address - Street 1:320 ROSS AVE STE 7
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-1816
Practice Address - Country:US
Practice Address - Phone:715-359-0229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38765000Medicaid
WIT63526Medicare UPIN
WI75334Medicare ID - Type Unspecified