Provider Demographics
NPI:1942401393
Name:TATRO, THAYNE A (DC)
Entity Type:Individual
Prefix:DR
First Name:THAYNE
Middle Name:A
Last Name:TATRO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 D ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBURY
Mailing Address - State:NE
Mailing Address - Zip Code:68352-2534
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:68352-2534
Practice Address - Country:US
Practice Address - Phone:402-729-5181
Practice Address - Fax:402-729-5182
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100251793-00Medicaid
NE09775OtherBLUE CROSS BLUE SHIELD
NE278237Medicare ID - Type Unspecified