Provider Demographics
NPI:1255451449
Name:DR. TROY TANN S.C.
Entity type:Organization
Organization Name:DR. TROY TANN S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:TANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-370-2299
Mailing Address - Street 1:2112 WINDING RIVER DR
Mailing Address - Street 2:SUITE #120
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8554
Mailing Address - Country:US
Mailing Address - Phone:630-428-2299
Mailing Address - Fax:630-904-2299
Practice Address - Street 1:2112 WINDING RIVER DR
Practice Address - Street 2:SUITE #120
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8554
Practice Address - Country:US
Practice Address - Phone:630-428-2299
Practice Address - Fax:630-904-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2222492OtherBCBS IN NETWORK PROVIDER
IL3668098OtherAETNA IN NETWORK PROVIDER
IL911-3986OtherPHCS IN NETWORK PROVIDER