Provider Demographics
NPI:1124425384
Name:TAMBASCIO, KATHERINE (DC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:TAMBASCIO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2796 LYCOMING MALL DR
Mailing Address - Street 2:
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756-6466
Mailing Address - Country:US
Mailing Address - Phone:570-546-5454
Mailing Address - Fax:
Practice Address - Street 1:8 CEDAR ST STE 61
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6362
Practice Address - Country:US
Practice Address - Phone:814-600-9397
Practice Address - Fax:781-305-3124
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010898111N00000X
MA3705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor