Provider Demographics
NPI:1568877009
Name:TANNER, KIRBY (DC)
Entity Type:Individual
Prefix:DR
First Name:KIRBY
Middle Name:
Last Name:TANNER
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 1:2278 WILLOW RUN
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-5639
Mailing Address - Country:US
Mailing Address - Phone:409-748-9684
Mailing Address - Fax:
Practice Address - Street 1:2253 N LOOP 336 W STE C
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3630
Practice Address - Country:US
Practice Address - Phone:936-441-9990
Practice Address - Fax:936-441-9991
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor