Provider Demographics
NPI:1932145786
Name:SCHARICH, TARA DAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:DAWN
Last Name:SCHARICH
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 1:2600 LINCOLN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3305
Mailing Address - Country:US
Mailing Address - Phone:269-556-9654
Mailing Address - Fax:269-556-9735
Practice Address - Street 1:2600 LINCOLN AVE STE A
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-3305
Practice Address - Country:US
Practice Address - Phone:269-556-9654
Practice Address - Fax:269-556-9735
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITC009168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP5008001Medicare PIN