Provider Demographics
NPI:1821139452
Name:FRISINA, TANA (DC)
Entity Type:Individual
Prefix:
First Name:TANA
Middle Name:
Last Name:FRISINA
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 1:1533 S MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-3620
Mailing Address - Country:US
Mailing Address - Phone:217-787-4345
Mailing Address - Fax:217-787-4641
Practice Address - Street 1:1533 S MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-3620
Practice Address - Country:US
Practice Address - Phone:217-787-4345
Practice Address - Fax:217-787-4641
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL075618OtherHEALTH ALLIANCE PIN #
ILBS08432055OtherBLUE CROSS BLUE SHIELD ID
ILBS08432055OtherBLUE CROSS BLUE SHIELD ID