Provider Demographics
NPI:1720361801
Name:TARNICK, CHAD TIMOTHY (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:TIMOTHY
Last Name:TARNICK
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 1:5040 E SHEA BLVD
Mailing Address - Street 2:STE 160
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4600
Mailing Address - Country:US
Mailing Address - Phone:480-625-4288
Mailing Address - Fax:480-625-4288
Practice Address - Street 1:5040 E SHEA BLVD
Practice Address - Street 2:STE 160
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4600
Practice Address - Country:US
Practice Address - Phone:480-625-4288
Practice Address - Fax:480-625-4288
Is Sole Proprietor?:No
Enumeration Date:2011-09-24
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ149382OtherMEDICARE PTAN