Provider Demographics
NPI:1295837029
Name:TAVANLAR-AMATO, ELGEE ASTORIA (DC)
Entity Type:Individual
Prefix:
First Name:ELGEE
Middle Name:ASTORIA
Last Name:TAVANLAR-AMATO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ELGEE
Other - Middle Name:ASTORIA
Other - Last Name:TAVANLAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1200 ARTESIA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2755
Mailing Address - Country:US
Mailing Address - Phone:310-374-9025
Mailing Address - Fax:310-318-7944
Practice Address - Street 1:1200 ARTESIA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2755
Practice Address - Country:US
Practice Address - Phone:310-374-9025
Practice Address - Fax:310-318-7944
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23598111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23598Medicare ID - Type Unspecified