1972627271 NPI number — DR. TROY MARK TANN B.S.N., D.C.

Table of content: DR. TROY MARK TANN B.S.N., D.C. (NPI 1972627271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972627271 NPI number — DR. TROY MARK TANN B.S.N., D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANN
Provider First Name:
TROY
Provider Middle Name:
MARK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
B.S.N., D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972627271
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
764 SUMAC DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60506-8875
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-897-6082
Provider Business Mailing Address Fax Number:
630-897-6053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2112 WINDING RIVER DR
Provider Second Line Business Practice Location Address:
SUITE#120
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60564-8554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-428-2299
Provider Business Practice Location Address Fax Number:
630-904-2299
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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