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General NPI Number Information
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NPI Number | 1174669014
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Entity Type | Organization
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Legal Business Name | TANZAR CHIROPRACTIC WELLCARE CENTER
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/23/2013
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Provider Practice Location Address
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Address Line | 1088 VISTA PARK DR SUITE C
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City | FOREST
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State | VA
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Zip | 24551-2761
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Country | US
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Telephone | 434-385-1110
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Fax | 434-385-1115
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Provider Business Mailing Address
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Address Line | 1088 VISTA PARK DR SUITE C
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City | FOREST
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State | VA
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Zip | 24551-2761
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Country | US
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Telephone | 434-385-1110
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Fax | 434-385-1115
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFF S TANZAR
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Credential | D.C
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Telephone | 434-385-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0104001938
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License Number State | VA
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