Provider Demographics
NPI:1174669014
Name:TANZAR CHIROPRACTIC WELLCARE CENTER
Entity Type:Organization
Organization Name:TANZAR CHIROPRACTIC WELLCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:S
Authorized Official - Last Name:TANZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-385-1110
Mailing Address - Street 1:1088 VISTA PARK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2761
Mailing Address - Country:US
Mailing Address - Phone:434-385-1110
Mailing Address - Fax:434-385-1115
Practice Address - Street 1:1088 VISTA PARK DR
Practice Address - Street 2:SUITE C
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2761
Practice Address - Country:US
Practice Address - Phone:434-385-1110
Practice Address - Fax:434-385-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA287170OtherANTHEM BLUE CROSS BLUE SH
VAC09304OtherMEDICARE GROUP PTAN
VA00W170T01OtherMEDICARE INDIVIDUAL PTAN
VA00W170T01OtherMEDICARE INDIVIDUAL PTAN