Provider Demographics
NPI:1962546986
Name:WOLLER-LI, TAMARA (DC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:WOLLER-LI
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 1:1283 E OGDEN AVE
Mailing Address - Street 2:#183
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1616
Mailing Address - Country:US
Mailing Address - Phone:630-717-0011
Mailing Address - Fax:630-717-6611
Practice Address - Street 1:1283 E OGDEN AVE
Practice Address - Street 2:#183
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1616
Practice Address - Country:US
Practice Address - Phone:630-717-0011
Practice Address - Fax:630-717-6611
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor