Provider Demographics
NPI:1306210612
Name:WORKMAN, TARA E (DC)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:E
Last Name:WORKMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TARA
Other - Middle Name:E
Other - Last Name:KOECKRITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3161 E PALMER WASILLA HWY STE 1C
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7271
Mailing Address - Country:US
Mailing Address - Phone:907-357-1818
Mailing Address - Fax:907-357-1814
Practice Address - Street 1:3161 E PALMER WASILLA HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7271
Practice Address - Country:US
Practice Address - Phone:907-357-1818
Practice Address - Fax:907-357-1814
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2023-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK103116111NN1001X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1636141Medicaid
AK13661745OtherCAQH