Provider Demographics
NPI:1457664732
Name:TARNASKY, GIDEON MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:GIDEON
Middle Name:MICHAEL
Last Name:TARNASKY
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 1:9679 WELLS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97351-7902
Mailing Address - Country:US
Mailing Address - Phone:503-838-6491
Mailing Address - Fax:
Practice Address - Street 1:9679 WELLS LANDING RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OR
Practice Address - Zip Code:97351-7902
Practice Address - Country:US
Practice Address - Phone:503-838-6491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1890111N00000X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic