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General NPI Number Information
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NPI Number | 1194715417
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Entity Type | Individual
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Provider Name | TOM C TATASCIORE DC QME
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Gender | Male
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 530 WILSHIRE BLVD STE 202A
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City | SANTA MONICA
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State | CA
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Zip | 90401-1421
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Country | US
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Telephone | 310-576-1885
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Fax | 310-576-1873
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Provider Business Mailing Address
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Address Line | 530 WILSHIRE BLVD STE 202A
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City | SANTA MONICA
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State | CA
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Zip | 90401-1421
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Country | US
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Telephone | 310-576-1885
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Fax | 310-576-1873
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DC20814
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License Number State | CA
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