Provider Demographics
NPI:1518067982
Name:TANK, DAVID A (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:TANK
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 1:1953 BARDSTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40069-8402
Mailing Address - Country:US
Mailing Address - Phone:859-336-0009
Mailing Address - Fax:859-336-0009
Practice Address - Street 1:1953 BARDSTOWN ROAD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:KY
Practice Address - Zip Code:40069-8402
Practice Address - Country:US
Practice Address - Phone:859-336-0009
Practice Address - Fax:859-336-0009
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1693301Medicare ID - Type Unspecified
KYU59918Medicare UPIN