Provider Demographics
NPI:1831266469
Name:DOUGLAS, TARA ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:ELIZABETH
Last Name:DOUGLAS
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 1:211 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2525
Mailing Address - Country:US
Mailing Address - Phone:503-545-4474
Mailing Address - Fax:
Practice Address - Street 1:211 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2525
Practice Address - Country:US
Practice Address - Phone:256-861-8546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034416111N00000X
OR283579111N00000X
AL2686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor