Provider Demographics
NPI:1902804255
Name:WORRON, TARA L (DC)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:L
Last Name:WORRON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2842 ROUTE 34
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8346
Mailing Address - Country:US
Mailing Address - Phone:630-554-9323
Mailing Address - Fax:630-554-9328
Practice Address - Street 1:2842 ROUTE 34
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8346
Practice Address - Country:US
Practice Address - Phone:630-554-9323
Practice Address - Fax:630-554-9328
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008826111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV04312Medicare UPIN
ILK15944Medicare ID - Type Unspecified