Provider Demographics
NPI:1992085047
Name:TOMMAN, TARA E (DC)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:E
Last Name:TOMMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TARA
Other - Middle Name:E
Other - Last Name:KEIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3426 LINCOLN RD
Mailing Address - Street 2:HAMILTON
Mailing Address - City:HAMILTON
Mailing Address - State:MI
Mailing Address - Zip Code:49419-9512
Mailing Address - Country:US
Mailing Address - Phone:269-751-2670
Mailing Address - Fax:
Practice Address - Street 1:3426 LINCOLN RD
Practice Address - Street 2:HAMILTON
Practice Address - City:HAMILTON
Practice Address - State:MI
Practice Address - Zip Code:49419-9512
Practice Address - Country:US
Practice Address - Phone:269-751-2670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
N97340002Medicare PIN