Provider Demographics
NPI:1053336735
Name:PLOTKIN, TAMARA LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:LYNN
Last Name:PLOTKIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 CANOGA AVE
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-4103
Mailing Address - Country:US
Mailing Address - Phone:818-887-0651
Mailing Address - Fax:
Practice Address - Street 1:8111 CANOGA AVE
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-4103
Practice Address - Country:US
Practice Address - Phone:818-887-0651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0204850OtherBLUE SHIELD
CAW16430Medicare ID - Type UnspecifiedCHIROPRACTOR