Provider Demographics
NPI:1144001199
Name:TANNER, AIMEE M (DC, MS, FIAMA)
Entity type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:M
Last Name:TANNER
Suffix:
Gender:F
Credentials:DC, MS, FIAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 NW 47TH DR
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-6852
Mailing Address - Country:US
Mailing Address - Phone:801-597-5366
Mailing Address - Fax:
Practice Address - Street 1:3407 NW 47TH DR
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-6852
Practice Address - Country:US
Practice Address - Phone:801-597-5366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6329111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician