Provider Demographics
NPI:1568513158
Name:DORHOUT, TAMMY R (DC CCSP FIACA)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:R
Last Name:DORHOUT
Suffix:
Gender:F
Credentials:DC CCSP FIACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6102 N 16 ST
Mailing Address - Street 2:#13
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016
Mailing Address - Country:US
Mailing Address - Phone:602-263-0266
Mailing Address - Fax:602-263-0265
Practice Address - Street 1:6102 N 16 ST
Practice Address - Street 2:#13
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016
Practice Address - Country:US
Practice Address - Phone:602-263-0266
Practice Address - Fax:602-263-0265
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0238760OtherBCBS
AZ0238760OtherBCBS