MEDICARE: DR. DOUGLAS SCOTT TANNER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	3510	AZ

General Provider Information

NPI Number	:	1033273396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS SCOTT TANNER D.C.

Provider Business Mailing Address
First Line	:	PO BOX 38102
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85069-8102
Country	:	US
Telephone Number	:	602-433-9790
Fax Number	:	602-433-5254

Provider Business Practice Location Address
First Line	:	7840 N 31ST AVE
Second Line	:	103
City	:	PHOENIX
State	:	AZ
Zip	:	85051-6687
Country	:	US
Telephone Number	:	602-433-9790
Fax Number	:	602-433-5254

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	07/08/2007

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