Provider Demographics
NPI:1174783724
Name:BARNHART, TAMARA MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:MARIE
Last Name:BARNHART
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TAMARA
Other - Middle Name:MARIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:6101 E HIGHWAY 54
Mailing Address - Street 2:UNIT A
Mailing Address - City:ATHOL
Mailing Address - State:ID
Mailing Address - Zip Code:83801-8255
Mailing Address - Country:US
Mailing Address - Phone:208-704-9504
Mailing Address - Fax:
Practice Address - Street 1:6101 E HIGHWAY 54
Practice Address - Street 2:UNIT A
Practice Address - City:ATHOL
Practice Address - State:ID
Practice Address - Zip Code:83801-8255
Practice Address - Country:US
Practice Address - Phone:208-704-9504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60020325111N00000X
IDCHIA- 1340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor