Provider Demographics
NPI:1265775951
Name:TAT WELLNESS PLLC
Entity type:Organization
Organization Name:TAT WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:ALLYCE
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-798-3101
Mailing Address - Street 1:1625 N BELL BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7055
Mailing Address - Country:US
Mailing Address - Phone:309-798-3101
Mailing Address - Fax:
Practice Address - Street 1:1625 N BELL BLVD STE H
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7055
Practice Address - Country:US
Practice Address - Phone:309-798-3101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992081459OtherNPPES