Provider Demographics
NPI:1720096563
Name:JANTZ, TANYA RHEA (DC)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:RHEA
Last Name:JANTZ
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:PO BOX 335
Mailing Address - Street 2:101 W KANSAS
Mailing Address - City:CIMARRON
Mailing Address - State:KS
Mailing Address - Zip Code:67835-0335
Mailing Address - Country:US
Mailing Address - Phone:620-855-2163
Mailing Address - Fax:620-855-2488
Practice Address - Street 1:101 W KANSAS
Practice Address - Street 2:
Practice Address - City:CIMARRON
Practice Address - State:KS
Practice Address - Zip Code:67835-0335
Practice Address - Country:US
Practice Address - Phone:620-855-2163
Practice Address - Fax:620-855-2488
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104128111N00000X
CO3660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS023754OtherBCBS
U37224Medicare UPIN
023754Medicare ID - Type Unspecified