=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073826533
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIANNE A PAPE D.C., M.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2010
-----------------------------------------------------
Last Update Date | 04/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 305 FLANDERS RD SUITE #6
-----------------------------------------------------
City | EAST LYME
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06333-1743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-739-3600
-----------------------------------------------------
Fax | 860-739-3600
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 944
-----------------------------------------------------
City | EAST LYME
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06333-0944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-739-3400
-----------------------------------------------------
Fax | 860-739-3600
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NN1001X
-----------------------------------------------------
Taxonomy Name | Nutrition Chiropractor
-----------------------------------------------------
License Number | 1857
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------