Provider Demographics
NPI:1336601681
Name:ELLER, TAMARIE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:TAMARIE
Middle Name:ANN
Last Name:ELLER
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 1:22398 S BALD HILL RD
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-1582
Mailing Address - Country:US
Mailing Address - Phone:918-931-8192
Mailing Address - Fax:
Practice Address - Street 1:22398 S BALD HILL RD
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-1582
Practice Address - Country:US
Practice Address - Phone:918-931-8192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty