Provider Demographics
NPI:1346451101
Name:LAWICKI, TARAANNE KEATING (DC)
Entity Type:Individual
Prefix:
First Name:TARAANNE
Middle Name:KEATING
Last Name:LAWICKI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:ANNE
Other - Last Name:KEATING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:590 HIGHWAY 35
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5048
Mailing Address - Country:US
Mailing Address - Phone:732-796-0333
Mailing Address - Fax:732-796-0335
Practice Address - Street 1:590 HIGHWAY 35
Practice Address - Street 2:SUITE 1
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5048
Practice Address - Country:US
Practice Address - Phone:732-796-0333
Practice Address - Fax:732-796-0335
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556531111N00000X
NJ38MC00680800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104556531OtherSTATE MEDICAL LICENSE #
NJ38MC00680800OtherSTATE MEDICAL LICENSE #