Provider Demographics
NPI:1144318411
Name:DARRAGH, TAMARA ANN SUKUP (ND, DC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:ANN SUKUP
Last Name:DARRAGH
Suffix:
Gender:F
Credentials:ND, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LEAF WING DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55127-6162
Mailing Address - Country:US
Mailing Address - Phone:612-202-1417
Mailing Address - Fax:
Practice Address - Street 1:12 LEAF WING DR
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55127-6162
Practice Address - Country:US
Practice Address - Phone:612-202-1417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4729111N00000X
VT099.0086731175F00000X
MN1046175F00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No111N00000XChiropractic ProvidersChiropractor