| Dr Dustin James Tanner, DC | |
|
2200 N Ponce De Leon Blvd, Suite #1, St Augustine, FL 32084-2600 | |
| (904) 819-9110 | |
| (904) 819-9310 |
| Full Name | Dr Dustin James Tanner |
|---|---|
| Gender | Male |
| Speciality | Chiropractor |
| Location | 2200 N Ponce De Leon Blvd, St Augustine, Florida |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790012201 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | CH 10578 (Florida) | Primary |
| 111N00000X | Chiropractor | X012022-1 (New York) | Secondary |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Dustin James Tanner, DC 2200 N Ponce De Leon Blvd, Suite #1, St Augustine, FL 32084-2600 Ph: (315) 224-4042 | Dr Dustin James Tanner, DC 2200 N Ponce De Leon Blvd, Suite #1, St Augustine, FL 32084-2600 Ph: (904) 819-9110 |
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