Provider Demographics
NPI:1407260425
Name:COLEMAN, TANNER WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:TANNER
Middle Name:WAYNE
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S WEST END ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5239
Mailing Address - Country:US
Mailing Address - Phone:479-751-8686
Mailing Address - Fax:
Practice Address - Street 1:1000 S WEST END ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5239
Practice Address - Country:US
Practice Address - Phone:479-751-8686
Practice Address - Fax:479-751-6022
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16374111N00000X, 111NI0013X
MO2015005071111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner