Provider Demographics
NPI:1598327447
Name:CORWIN, TARA (DC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:CORWIN
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 1:1201 NW JEFFERSON ST STE C
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-6400
Mailing Address - Country:US
Mailing Address - Phone:816-888-0719
Mailing Address - Fax:
Practice Address - Street 1:1201 NW JEFFERSON ST STE C
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-6400
Practice Address - Country:US
Practice Address - Phone:816-888-0719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019024296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor