Healthcare Provider Details

I. General information

NPI: 1821015884
Provider Name (Legal Business Name): TATRO CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 D ST
FAIRBURY NE
68352
US

IV. Provider business mailing address

425 D ST
FAIRBURY NE
68352
US

V. Phone/Fax

Practice location:
  • Phone: 402-729-5181
  • Fax: 402-729-5182
Mailing address:
  • Phone: 402-729-5181
  • Fax: 402-729-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1277
License Number StateNE

VIII. Authorized Official

Name: THAYNE ALAN TATRO
Title or Position: OWNER PRESIDENT
Credential: DC
Phone: 402-729-5181