Provider Demographics
NPI:1477680379
Name:ROMAN, TARA LYN (DC)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LYN
Last Name:ROMAN
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 1:10357 WINDROSE CURV
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:MN
Mailing Address - Zip Code:55020-8504
Mailing Address - Country:US
Mailing Address - Phone:952-461-1312
Mailing Address - Fax:
Practice Address - Street 1:16228 MAIN AVE SE
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-1770
Practice Address - Country:US
Practice Address - Phone:952-226-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4153111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition