Provider Demographics
NPI:1346543824
Name:GEISE, TARA (DC)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:GEISE
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 1:325 MIRON DR
Mailing Address - Street 2:SUITE #100
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7832
Mailing Address - Country:US
Mailing Address - Phone:469-223-8836
Mailing Address - Fax:
Practice Address - Street 1:325 MIRON DR
Practice Address - Street 2:SUITE #100
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7832
Practice Address - Country:US
Practice Address - Phone:469-223-8836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor