Provider Demographics
NPI:1538246533
Name:SANTA ANA, TAMARA GAIL (DC)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:GAIL
Last Name:SANTA ANA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:GAIL
Other - Last Name:SANTA ANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:17 A SOUTH RANDOLPH STREET
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-2432
Mailing Address - Country:US
Mailing Address - Phone:540-463-2462
Mailing Address - Fax:540-463-2469
Practice Address - Street 1:17 A SOUTH RANDOLPH STREET
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2432
Practice Address - Country:US
Practice Address - Phone:540-463-2462
Practice Address - Fax:540-463-2469
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001369111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition