Provider Demographics
NPI:1063628790
Name:NAZAR, TANA MARIA (DC)
Entity Type:Individual
Prefix:DR
First Name:TANA
Middle Name:MARIA
Last Name:NAZAR
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 1:4802 DERRY ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3440
Mailing Address - Country:US
Mailing Address - Phone:717-561-2247
Mailing Address - Fax:717-561-1744
Practice Address - Street 1:4800 DERRY ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-3440
Practice Address - Country:US
Practice Address - Phone:717-564-1550
Practice Address - Fax:717-561-1744
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006912L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU65447Medicare UPIN