Provider Demographics
NPI:1841328721
Name:TANKERSLEY CHIROPRACTIC PA
Entity type:Organization
Organization Name:TANKERSLEY CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:TANKERSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-238-1777
Mailing Address - Street 1:2327 NW FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-9311
Mailing Address - Country:US
Mailing Address - Phone:615-420-0007
Mailing Address - Fax:615-826-7889
Practice Address - Street 1:2327 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-9311
Practice Address - Country:US
Practice Address - Phone:722-238-1777
Practice Address - Fax:772-222-6449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU54098Medicare UPIN
TN3732915Medicare ID - Type UnspecifiedCIGNA MEDICARE