Provider Demographics
NPI:1538306832
Name:KOFF, TARA B (DC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:B
Last Name:KOFF
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 1:9387 FORESTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4701
Mailing Address - Country:US
Mailing Address - Phone:703-361-0251
Mailing Address - Fax:703-361-8853
Practice Address - Street 1:9387 FORESTWOOD LN
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4701
Practice Address - Country:US
Practice Address - Phone:703-361-0251
Practice Address - Fax:703-361-8853
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA019374C86Medicare PIN