Provider Demographics
NPI:1023211554
Name:DANLI, TARA ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:ROSE
Last Name:DANLI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 LORTON AVENUE
Mailing Address - Street 2:STE. 203
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4151
Mailing Address - Country:US
Mailing Address - Phone:650-343-3444
Mailing Address - Fax:650-343-3464
Practice Address - Street 1:340 LORTON AVE
Practice Address - Street 2:STE. 203
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4151
Practice Address - Country:US
Practice Address - Phone:650-343-3444
Practice Address - Fax:650-343-3464
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 26374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0263740Medicare ID - Type Unspecified