Healthcare Provider Details

I. General information

NPI: 1336601681
Provider Name (Legal Business Name): TAMARIE ANN ELLER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22398 S BALD HILL RD
TAHLEQUAH OK
74464-1582
US

IV. Provider business mailing address

22398 S BALD HILL RD
TAHLEQUAH OK
74464-1582
US

V. Phone/Fax

Practice location:
  • Phone: 918-931-8192
  • Fax:
Mailing address:
  • Phone: 918-931-8192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2038
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: