Provider Demographics
NPI:1508980558
Name:TARJOMAN, MIKE S (DC)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:S
Last Name:TARJOMAN
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 1:18617 LE DAUPHINE PL
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-2886
Mailing Address - Country:US
Mailing Address - Phone:813-738-3888
Mailing Address - Fax:813-738-3888
Practice Address - Street 1:14502 N DALE MABRY HWY STE 104
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2076
Practice Address - Country:US
Practice Address - Phone:813-738-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26497111N00000X
FLCH13493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26497Medicare PIN