=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376501569
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TARA ELLEN HORRALL D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2006
-----------------------------------------------------
Last Update Date | 04/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 113 S WHITE CHURCH RD
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47670-8106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-240-0555
-----------------------------------------------------
Fax | 618-240-0555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 113 S WHITE CHURCH RD
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47670-8106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-240-0555
-----------------------------------------------------
Fax | 618-240-0555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038-010058
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 08002205A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------