Provider Demographics
NPI:1629707294
Name:MAZOUR, TANNER (DC)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:MAZOUR
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 1:1633 W MAIN ST STE 401
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-7804
Mailing Address - Country:US
Mailing Address - Phone:402-741-2857
Mailing Address - Fax:
Practice Address - Street 1:1633 W MAIN ST STE 401
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-7804
Practice Address - Country:US
Practice Address - Phone:615-444-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor