Provider Demographics
NPI:1710195052
Name:AVERILL, TANYA (DC)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:
Last Name:AVERILL
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 1:602 N MAY UNIT 82
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-7506
Mailing Address - Country:US
Mailing Address - Phone:480-626-0145
Mailing Address - Fax:
Practice Address - Street 1:10313 N SCOTTSDALE RD
Practice Address - Street 2:SUITE A
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-4538
Practice Address - Country:US
Practice Address - Phone:480-991-1291
Practice Address - Fax:480-368-5877
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7500111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation