Provider Demographics
NPI:1265692867
Name:TOMKO, STEPHEN R (DC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:TOMKO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:R
Other - Last Name:TOMKO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:848 S DENTON TAP RD STE 200
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4583
Mailing Address - Country:US
Mailing Address - Phone:972-462-9161
Mailing Address - Fax:903-274-4524
Practice Address - Street 1:848 S DENTON TAP RD STE 200
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4583
Practice Address - Country:US
Practice Address - Phone:972-462-9161
Practice Address - Fax:972-393-4131
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2600111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner