Provider Demographics
NPI: | 1417071234 |
---|---|
Name: | TADAAR, P.A. |
Entity Type: | Organization |
Organization Name: | TADAAR, P.A. |
Other - Org Name: | MOUNTAIN AIR WELLNESS CENTERS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PHYSICIAN |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JIM |
Authorized Official - Middle Name: | W |
Authorized Official - Last Name: | JOHNSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 828-743-9070 |
Mailing Address - Street 1: | PO BOX 1853 |
Mailing Address - Street 2: | |
Mailing Address - City: | CASHIERS |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28717-1853 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 828-743-9070 |
Mailing Address - Fax: | 828-743-6370 |
Practice Address - Street 1: | 130 HWY 64 EAST |
Practice Address - Street 2: | |
Practice Address - City: | CASHIERS |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28717 |
Practice Address - Country: | US |
Practice Address - Phone: | 828-743-9070 |
Practice Address - Fax: | 828-743-6370 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-19 |
Last Update Date: | 2010-09-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 847 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |