MEDICARE: DR. LORA L TANIS DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	MC03939	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134268337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORA L TANIS DC

Provider Business Mailing Address
First Line	:	1900 UNION VALLEY RD
Second Line	:	SUITE 201
City	:	HEWITT
State	:	NJ
Zip	:	07421
Country	:	US
Telephone Number	:	973-728-1188
Fax Number	:	973-728-1033

Provider Business Practice Location Address
First Line	:	1900 UNION VALLEY RD
Second Line	:	SUITE 201
City	:	HEWITT
State	:	NJ
Zip	:	07421
Country	:	US
Telephone Number	:	973-728-1188
Fax Number	:	973-728-1033

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	12/21/2011

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Directions to “ DR. LORA L TANIS DC” Practice Location

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