Provider Demographics
NPI:1285984906
Name:MOCHACHE, TANKISO KATLEHO (DC)
Entity type:Individual
Prefix:
First Name:TANKISO
Middle Name:KATLEHO
Last Name:MOCHACHE
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 1:2922 ALOUETTE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8136
Mailing Address - Country:US
Mailing Address - Phone:972-955-4134
Mailing Address - Fax:817-633-4464
Practice Address - Street 1:2922 ALOUETTE DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8136
Practice Address - Country:US
Practice Address - Phone:972-955-4134
Practice Address - Fax:817-633-4464
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12064111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation