Provider Demographics
NPI:1356437966
Name:TANELLA, ROBERT THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THOMAS
Last Name:TANELLA
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 1:652 W BLONDY JHUNE RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8104
Mailing Address - Country:US
Mailing Address - Phone:972-390-2273
Mailing Address - Fax:972-747-1114
Practice Address - Street 1:210 S CENTRAL EXPRESSWAY
Practice Address - Street 2:SUITE 91
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013
Practice Address - Country:US
Practice Address - Phone:972-390-2273
Practice Address - Fax:972-747-1114
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT16201Medicare UPIN
TX8F21190Medicare PIN