Provider Demographics
NPI:1346224151
Name:WHELAN, TARA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:LYNN
Last Name:WHELAN
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 1:421 NEW LONDON RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7009
Mailing Address - Country:US
Mailing Address - Phone:302-369-2940
Mailing Address - Fax:302-369-2949
Practice Address - Street 1:421 NEW LONDON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7009
Practice Address - Country:US
Practice Address - Phone:302-369-2940
Practice Address - Fax:302-369-2949
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000023575Medicaid
DE00B156B62Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE
DE1000023575Medicaid
DEG00862Medicare ID - Type UnspecifiedGROUP NUMBER