Provider Demographics
NPI:1679790703
Name:TOMKINSON, DEVON (DC)
Entity type:Individual
Prefix:DR
First Name:DEVON
Middle Name:
Last Name:TOMKINSON
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 1:460 LINCOLN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMERICAN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83211-1740
Mailing Address - Country:US
Mailing Address - Phone:208-226-7644
Mailing Address - Fax:
Practice Address - Street 1:460 LINCOLN ST
Practice Address - Street 2:SUITE B
Practice Address - City:AMERICAN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83211-1740
Practice Address - Country:US
Practice Address - Phone:208-226-7644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDU80167Medicare UPIN