Provider Demographics
NPI:1558328039
Name:WHITEMAN-FAGER, TARA LYNN (DC)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LYNN
Last Name:WHITEMAN-FAGER
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 1:2010 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 42
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4134
Mailing Address - Country:US
Mailing Address - Phone:847-593-3330
Mailing Address - Fax:
Practice Address - Street 1:2010 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 42
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4134
Practice Address - Country:US
Practice Address - Phone:847-593-3330
Practice Address - Fax:847-593-3346
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623079OtherBLUE CROSS PROVIDER NO.
ILV08641Medicare UPIN
IL01623079OtherBLUE CROSS PROVIDER NO.