Provider Demographics
NPI:1184769259
Name:TANELLA FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:TANELLA FAMILY CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANGER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-390-2273
Mailing Address - Street 1:1024 S GREENVILLE AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3337
Mailing Address - Country:US
Mailing Address - Phone:972-390-2273
Mailing Address - Fax:972-747-1114
Practice Address - Street 1:210 SOUTH CENTRAL EXPWY
Practice Address - Street 2:SUITE 91
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002
Practice Address - Country:US
Practice Address - Phone:972-390-2273
Practice Address - Fax:972-747-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00904ZMedicare PIN