Individual
MS. TAMARA SUE PORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
1005 W COLUMBIA, SOMERSET, KY 42503
(606) 679-1166
(606) 679-1167
Mailing address
PO BOX 3334, WEST SOMERSET, KY 42564
(606) 679-1166
(606) 679-1167
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4828
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000323394
ANTHEM
—
05
—
85002947
—
KY
Enumeration date
07/28/2006
Last updated
07/08/2007
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