Provider Demographics
NPI:1194715417
Name:TATASCIORE, TOM C (DC QME)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:C
Last Name:TATASCIORE
Suffix:
Gender:M
Credentials:DC QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 WILSHIRE BLVD
Mailing Address - Street 2:STE 202A
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1421
Mailing Address - Country:US
Mailing Address - Phone:310-576-1885
Mailing Address - Fax:310-576-1873
Practice Address - Street 1:530 WILSHIRE BLVD
Practice Address - Street 2:STE 202A
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1421
Practice Address - Country:US
Practice Address - Phone:310-576-1885
Practice Address - Fax:310-576-1873
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20814111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC20814Medicare ID - Type Unspecified
U41372Medicare UPIN