Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1326 | HI |
NPI | 1003045295 |
---|---|
Provider Name | Ms. Tara Tedrick |
First Address | Kailua, HI 96734-1883 |
Second Address | Kailua, HI 96734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2009 |
Last Update Date | 14/03/2016 |