Provider Demographics
NPI:1558479832
Name:TAU, RISA LAUREN (DC)
Entity Type:Individual
Prefix:DR
First Name:RISA
Middle Name:LAUREN
Last Name:TAU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:RISA
Other - Middle Name:LAUREN
Other - Last Name:GILDINER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1431 KNIGHTSBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1446
Mailing Address - Country:US
Mailing Address - Phone:267-337-0369
Mailing Address - Fax:
Practice Address - Street 1:1431 KNIGHTSBRIDGE DR
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1446
Practice Address - Country:US
Practice Address - Phone:267-337-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007189-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU91155Medicare UPIN
PA059860 QTFMedicare ID - Type UnspecifiedGROUP ID#
PA059870 QTFMedicare ID - Type UnspecifiedMEMBER/INDIV. ID#