Provider Demographics
NPI:1336160449
Name:TOMALIN, GREG S (DC)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:S
Last Name:TOMALIN
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 1:13606 XAVIER LN
Mailing Address - Street 2:UNIT D
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-3604
Mailing Address - Country:US
Mailing Address - Phone:720-887-0624
Mailing Address - Fax:720-887-0632
Practice Address - Street 1:13606 XAVIER LN
Practice Address - Street 2:UNIT D
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-3604
Practice Address - Country:US
Practice Address - Phone:720-887-0624
Practice Address - Fax:720-887-0632
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO804542Medicare ID - Type Unspecified
V08192Medicare UPIN