Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1890 | OR |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 1890 | OR |
NPI | 1457664732 |
---|---|
Provider Name | Gideon Michael Tarnasky |
First Address | Independence, OR 97351-7902 |
Second Address | Independence, OR 97351-7902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2010 |
Last Update Date | 15/07/2010 |