1265864813 NPI number — THASSANEE CROSS LMP

Table of content: THASSANEE CROSS LMP (NPI 1265864813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265864813 NPI number — THASSANEE CROSS LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROSS
Provider First Name:
THASSANEE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265864813
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4122 FACTORIA BLVD SE STE 202
Provider Second Line Business Mailing Address:
CUMMINS CHIROPRACTIC
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98006-5259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-590-9158
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4122 FACTORIA BLVD SE STE 202
Provider Second Line Business Practice Location Address:
CUMMINS CHIROPRACTIC
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98006-5259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-590-9158
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA60331794 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MA60331794 . This is a "WASHINGTON STATE LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com