Provider Demographics
NPI:1215290135
Name:DR. MARK M. TANNY
Entity type:Organization
Organization Name:DR. MARK M. TANNY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:MATHEW
Authorized Official - Last Name:TANNY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:413-582-9111
Mailing Address - Street 1:24 CENTER STREET
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3005
Mailing Address - Country:US
Mailing Address - Phone:413-582-9111
Mailing Address - Fax:413-582-0333
Practice Address - Street 1:24 CENTER STREET
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3005
Practice Address - Country:US
Practice Address - Phone:413-582-9111
Practice Address - Fax:413-582-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty