Provider Demographics
NPI:1134795453
Name:KLEIN, TANNER JOSEPH (DC)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:JOSEPH
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 N GOVERNMENT WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-3750
Mailing Address - Country:US
Mailing Address - Phone:208-664-1000
Mailing Address - Fax:
Practice Address - Street 1:2634 N GOVERNMENT WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-3750
Practice Address - Country:US
Practice Address - Phone:208-664-1000
Practice Address - Fax:208-664-1001
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-2121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor