Provider Demographics
NPI:1710987490
Name:VANASSE, TANYA J (DC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:J
Last Name:VANASSE
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 1:1227 MENOMONIE ST STE A
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-5996
Mailing Address - Country:US
Mailing Address - Phone:715-839-9999
Mailing Address - Fax:715-839-9978
Practice Address - Street 1:1227 MENOMONIE ST STE A
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5996
Practice Address - Country:US
Practice Address - Phone:715-839-9999
Practice Address - Fax:715-839-9978
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3856-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI043732396010OtherBLUE CROSS
U91660Medicare UPIN