Provider Demographics
NPI:1053646331
Name:OSTERHOLZ, TARA ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:ANNE
Last Name:OSTERHOLZ
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:PO BOX 930226
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-0226
Mailing Address - Country:US
Mailing Address - Phone:608-732-1037
Mailing Address - Fax:
Practice Address - Street 1:413 W VERONA AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1318
Practice Address - Country:US
Practice Address - Phone:608-732-1037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4535-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor