Provider Demographics
NPI:1063494755
Name:TARQUIN, GILLES HENRY (DC/PT)
Entity Type:Individual
Prefix:DR
First Name:GILLES
Middle Name:HENRY
Last Name:TARQUIN
Suffix:
Gender:M
Credentials:DC/PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3107 CARLSEN ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-4036
Mailing Address - Country:US
Mailing Address - Phone:510-525-1640
Mailing Address - Fax:510-525-1640
Practice Address - Street 1:6500 FAIRMOUNT AVE
Practice Address - Street 2:SUITE 7B
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3623
Practice Address - Country:US
Practice Address - Phone:510-682-3626
Practice Address - Fax:510-525-1640
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21819111N00000X
CAPT21819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist