MEDICARE: JOHN TANASSE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	CH00033999	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0151745	OTHER	WA	WORKER'S COMP PROVIDER #

General Provider Information

NPI Number	:	1548341670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN TANASSE D.C.

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

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

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	05/24/2016

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