Provider Demographics
NPI:1770619710
Name:MCCRANEY, TANNEIA L (DC)
Entity type:Individual
Prefix:DR
First Name:TANNEIA
Middle Name:L
Last Name:MCCRANEY
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 1:6130 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2311
Mailing Address - Country:US
Mailing Address - Phone:708-445-7615
Mailing Address - Fax:708-445-7709
Practice Address - Street 1:6130 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2311
Practice Address - Country:US
Practice Address - Phone:708-445-7615
Practice Address - Fax:708-445-7709
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038009268Medicaid
ILU84476Medicare UPIN
IL699960Medicare ID - Type Unspecified