Provider Demographics
NPI:1780923367
Name:PODOLAK, TANYA ANN (DC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:ANN
Last Name:PODOLAK
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 1:4131 W THUNDERBIRD RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-5341
Mailing Address - Country:US
Mailing Address - Phone:602-938-8868
Mailing Address - Fax:602-938-5084
Practice Address - Street 1:4131 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-5341
Practice Address - Country:US
Practice Address - Phone:602-938-8868
Practice Address - Fax:602-938-5084
Is Sole Proprietor?:No
Enumeration Date:2013-02-02
Last Update Date:2013-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor