Provider Demographics
NPI:1457423741
Name:TARTACK, JEFFREY S (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:TARTACK
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 1:1222 S ANDREWS AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1806
Mailing Address - Country:US
Mailing Address - Phone:954-764-4042
Mailing Address - Fax:954-764-7275
Practice Address - Street 1:1222 S ANDREWS AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1806
Practice Address - Country:US
Practice Address - Phone:954-764-4042
Practice Address - Fax:954-764-7275
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0008769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU87928Medicare UPIN