Provider Demographics
NPI:1306268214
Name:TAMMINGA, ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:TAMMINGA
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 1:12334 SHELBYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1471
Mailing Address - Country:US
Mailing Address - Phone:502-253-6770
Mailing Address - Fax:502-253-6772
Practice Address - Street 1:12334 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:KY
Practice Address - Zip Code:40243-1471
Practice Address - Country:US
Practice Address - Phone:502-253-6770
Practice Address - Fax:502-653-6772
Is Sole Proprietor?:No
Enumeration Date:2014-01-11
Last Update Date:2014-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor