Provider Demographics
NPI:1184636813
Name:SLUSHER, TAMARA RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:RENEE
Last Name:SLUSHER
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 1:11245 N MISSION RD
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-9301
Mailing Address - Country:US
Mailing Address - Phone:989-386-5437
Mailing Address - Fax:989-386-4442
Practice Address - Street 1:11245 N MISSION RD
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-9301
Practice Address - Country:US
Practice Address - Phone:989-386-5437
Practice Address - Fax:989-386-4442
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4775643Medicaid
MIM78830007Medicare ID - Type Unspecified