Healthcare Provider Details

I. General information

NPI: 1942401393
Provider Name (Legal Business Name): THAYNE A. TATRO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 D ST
FAIRBURY NE
68352-2534
US

IV. Provider business mailing address

425 D ST
FAIRBURY NE
68352-2534
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:
Title or Position:
Credential:
Phone: