Provider Demographics
NPI:1730454703
Name:TANNER CHIROPRACTIC
Entity type:Organization
Organization Name:TANNER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GEOFFREY
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:770-552-3282
Mailing Address - Street 1:8737 DUNWOODY PL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2985
Mailing Address - Country:US
Mailing Address - Phone:770-552-3282
Mailing Address - Fax:
Practice Address - Street 1:8737 DUNWOODY PL
Practice Address - Street 2:SUITE 1
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-2985
Practice Address - Country:US
Practice Address - Phone:770-552-3282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU77336Medicare UPIN