Provider Demographics
NPI:1609926070
Name:TARANTOLO, MARK ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:TARANTOLO
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:PO BOX 41143
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89504-5143
Mailing Address - Country:US
Mailing Address - Phone:775-338-3260
Mailing Address - Fax:775-337-6365
Practice Address - Street 1:1409 TONOPAH ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3425
Practice Address - Country:US
Practice Address - Phone:775-338-3260
Practice Address - Fax:775-337-6365
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVDC294Medicare PIN