Provider Demographics
NPI:1972627271
Name:TANN, TROY MARK (BSN, DC)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:MARK
Last Name:TANN
Suffix:
Gender:M
Credentials:BSN, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 SUMAC DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-8875
Mailing Address - Country:US
Mailing Address - Phone:630-897-6082
Mailing Address - Fax:630-897-6053
Practice Address - Street 1:2112 WINDING RIVER DR
Practice Address - Street 2:SUITE#120
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8554
Practice Address - Country:US
Practice Address - Phone:630-428-2299
Practice Address - Fax:630-904-2299
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician