Provider Demographics
NPI:1811126006
Name:TARA TEDRICK DC LLC
Entity type:Organization
Organization Name:TARA TEDRICK DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TEDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-254-5577
Mailing Address - Street 1:970 N KALAHEO AVE
Mailing Address - Street 2:SUITE C315
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1866
Mailing Address - Country:US
Mailing Address - Phone:808-254-5577
Mailing Address - Fax:
Practice Address - Street 1:970 N. KALAHEO AVE.
Practice Address - Street 2:C315
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-254-5577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty