Provider Demographics
NPI:1285800755
Name:TANIS CHIROPRACTIC PC
Entity type:Organization
Organization Name:TANIS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIRPROACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TANIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-728-1188
Mailing Address - Street 1:1900 UNION VALLEY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HEWITT
Mailing Address - State:NJ
Mailing Address - Zip Code:07421-3024
Mailing Address - Country:US
Mailing Address - Phone:973-728-1188
Mailing Address - Fax:973-728-1033
Practice Address - Street 1:1900 UNION VALLEY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HEWITT
Practice Address - State:NJ
Practice Address - Zip Code:07421-3024
Practice Address - Country:US
Practice Address - Phone:973-728-1188
Practice Address - Fax:973-728-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5643902Medicaid
NJ5643902Medicaid