MEDICARE: TANIS CHIROPRACTIC PC

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	:	1285800755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TANIS CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	1900 UNION VALLEY RD
Second Line	:	SUITE 201
City	:	HEWITT
State	:	NJ
Zip	:	07421-3024
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	:	07421-3024
Country	:	US
Telephone Number	:	973-728-1188
Fax Number	:	973-728-1033

Authorized Official
Title or Position	:	CHIRPROACTOR/OWNER
Name	:	DR. LORA L TANIS
Credential	:	DC
Telephone Number	:	973-728-1188

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	05/05/2008

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