Provider Demographics
NPI:1972839835
Name:TATARENKO, PETER S (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
Last Name:TATARENKO
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 1:871 ALLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1943
Mailing Address - Country:US
Mailing Address - Phone:973-405-5163
Mailing Address - Fax:973-365-8004
Practice Address - Street 1:871 ALLWOOD RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1943
Practice Address - Country:US
Practice Address - Phone:973-405-5163
Practice Address - Fax:973-365-8004
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00677900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor