MEDICARE: TAMARA ANN SUKUP DARRAGH ND, 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	4729	MN
2	175F00000X	Naturopath	099.0086731	VT
3	175F00000X	Naturopath	1046	MN

General Provider Information

NPI Number	:	1144318411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA ANN SUKUP DARRAGH ND, DC

Provider Business Mailing Address
First Line	:	12 LEAF WING DR
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55127-6162
Country	:	US
Telephone Number	:	612-202-1417
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 LEAF WING DR
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55127-6162
Country	:	US
Telephone Number	:	612-202-1417
Fax Number	:

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	03/19/2020

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