Provider Demographics
NPI:1629321062
Name:LOPOUR, TAMARA (DC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:LOPOUR
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 1:1136 E STUART ST STE 4207
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1193
Mailing Address - Country:US
Mailing Address - Phone:970-377-0055
Mailing Address - Fax:
Practice Address - Street 1:1136 E STUART ST
Practice Address - Street 2:STE 4207
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1193
Practice Address - Country:US
Practice Address - Phone:970-377-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7039111N00000X
NE1737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NA2260Medicare PIN