Provider Demographics
NPI:1265539233
Name:LOVE, TAMMY JO (DC)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:JO
Last Name:LOVE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:18281 MINNETONKA BLVD
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-3345
Mailing Address - Country:US
Mailing Address - Phone:952-475-0079
Mailing Address - Fax:952-475-1030
Practice Address - Street 1:18281 MINNETONKA BLVD
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-3345
Practice Address - Country:US
Practice Address - Phone:952-475-0079
Practice Address - Fax:952-475-1030
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN3658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU82339OtherMETROPOLITAN HEALTH PLAN
MN0533OtherHSM INC
MN60B92LOOtherBCBS
MN656384OtherC.C.M.I
MNU82339OtherMETROPOLITAN HEALTH PLAN