Provider Demographics
NPI:1356481006
Name:TANIS, DAVID B (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:TANIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1554 UNION VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-1357
Mailing Address - Country:US
Mailing Address - Phone:973-839-1119
Mailing Address - Fax:973-728-1033
Practice Address - Street 1:16 SKYLINE LKS DR
Practice Address - Street 2:SUITE 6
Practice Address - City:RINGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07456
Practice Address - Country:US
Practice Address - Phone:973-839-1119
Practice Address - Fax:973-616-9588
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT44577Medicare UPIN
NJ034941Medicare ID - Type Unspecified