Healthcare Provider Details

I. General information

NPI: 1164804399
Provider Name (Legal Business Name): TARRY CHIROPRACTIC PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6427 CENTURION DR
LANSING MI
48917-8295
US

IV. Provider business mailing address

6427 CENTURION DR
LANSING MI
48917-8295
US

V. Phone/Fax

Practice location:
  • Phone: 517-290-6272
  • Fax:
Mailing address:
  • Phone: 517-290-6272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY EDWARD TARRY
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 517-290-6272