Provider Demographics
NPI:1720195019
Name:THOMFORDE, TARA (DC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:THOMFORDE
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 1:1825 WASHINGTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-8932
Mailing Address - Country:US
Mailing Address - Phone:724-746-6840
Mailing Address - Fax:724-746-6870
Practice Address - Street 1:1825 WASHINGTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-8932
Practice Address - Country:US
Practice Address - Phone:724-746-6840
Practice Address - Fax:724-746-6870
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1807958OtherBLUES
PAV09131Medicare UPIN