Provider Demographics
NPI:1376501569
Name:HORRALL, TARA ELLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:ELLEN
Last Name:HORRALL
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 1:229 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62863-1608
Mailing Address - Country:US
Mailing Address - Phone:618-262-2222
Mailing Address - Fax:618-262-2224
Practice Address - Street 1:229 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863-1608
Practice Address - Country:US
Practice Address - Phone:618-262-2222
Practice Address - Fax:618-262-2224
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK27936Medicare UPIN