Provider Demographics
NPI:1659673267
Name:CHEUVRONT, TARA RENEE (DC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:RENEE
Last Name:CHEUVRONT
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 1:4705 CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-4103
Mailing Address - Country:US
Mailing Address - Phone:386-763-2718
Mailing Address - Fax:386-763-2719
Practice Address - Street 1:4705 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-4103
Practice Address - Country:US
Practice Address - Phone:386-763-2718
Practice Address - Fax:386-763-2719
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC01336111N00000X
FLCH10189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor