Individual
MRS. TARA LYN ROMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
16228 MAIN AVE SE, PRIOR LAKE, MN 55372-1770
(952) 226-1140
Mailing address
10357 WINDROSE CURV, ELKO, MN 55020-8504
(952) 461-1312
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
Primary
4153
MN
Other
Enumeration date
02/27/2007
Last updated
07/08/2007
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