1689744534 NPI number — TANASSE CHIROPRACTIC, INC.

Table of content: (NPI 1689744534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689744534 NPI number — TANASSE CHIROPRACTIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TANASSE CHIROPRACTIC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1689744534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
344 CLEVELAND AVE SE
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
TUMWATER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98501-3342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-357-5170
Provider Business Mailing Address Fax Number:
360-357-5173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
344 CLEVELAND AVE SE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
TUMWATER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98501-3342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-357-5170
Provider Business Practice Location Address Fax Number:
360-357-5173
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TANASSE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
FRANCIS
Authorized Official Title or Position:
OFFICER, OWNER
Authorized Official Telephone Number:
360-357-5170

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  CH00033999 , 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: 0151745 . This is a "WORKER'S COMPENSATION, WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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