MEDICARE: DR. TAMMY R DORHOUT DC CCSP FIACA

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	5003	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0238760	OTHER		BCBS

General Provider Information

NPI Number	:	1568513158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMMY R DORHOUT DC CCSP FIACA

Provider Business Mailing Address
First Line	:	6102 N 16 ST
Second Line	:	#13
City	:	PHOENIX
State	:	AZ
Zip	:	85016
Country	:	US
Telephone Number	:	602-263-0266
Fax Number	:	602-263-0265

Provider Business Practice Location Address
First Line	:	6102 N 16 ST
Second Line	:	#13
City	:	PHOENIX
State	:	AZ
Zip	:	85016
Country	:	US
Telephone Number	:	602-263-0266
Fax Number	:	602-263-0265

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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