Provider Demographics
NPI:1821015884
Name:TATRO CHIROPRACTIC PC
Entity Type:Organization
Organization Name:TATRO CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THAYNE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TATRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-729-5181
Mailing Address - Street 1:425 D ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBURY
Mailing Address - State:NE
Mailing Address - Zip Code:68352
Mailing Address - Country:US
Mailing Address - Phone:402-729-5181
Mailing Address - Fax:402-729-5182
Practice Address - Street 1:425 D ST
Practice Address - Street 2:
Practice Address - City:FAIRBURY
Practice Address - State:NE
Practice Address - Zip Code:68352
Practice Address - Country:US
Practice Address - Phone:402-729-5181
Practice Address - Fax:402-729-5182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09775OtherBLUE CROSS BLUE SHIELD
NE10025179300Medicaid
NE09775OtherBLUE CROSS BLUE SHIELD