Provider Demographics
NPI:1861555971
Name:TARDANICO, PHILIP A (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:A
Last Name:TARDANICO
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 1:792 SOUTHERN ARTERY
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5747
Mailing Address - Country:US
Mailing Address - Phone:617-479-7231
Mailing Address - Fax:617-328-8795
Practice Address - Street 1:792 SOUTHERN ARTERY
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5747
Practice Address - Country:US
Practice Address - Phone:617-479-7231
Practice Address - Fax:617-328-8795
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor