Provider Demographics
NPI:1588062236
Name:TOMBLIN, JUSTIN (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:TOMBLIN
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 1:2430 S INTERSTATE 35 E
Mailing Address - Street 2:SUITE 128
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-4986
Mailing Address - Country:US
Mailing Address - Phone:940-435-0505
Mailing Address - Fax:940-435-0528
Practice Address - Street 1:2430 S INTERSTATE 35 E
Practice Address - Street 2:SUITE 128
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-4986
Practice Address - Country:US
Practice Address - Phone:940-435-0505
Practice Address - Fax:940-435-0528
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor