Healthcare Provider Details

I. General information

NPI: 1467438325
Provider Name (Legal Business Name): CHRISTOPHER PAUL TADLOCK HEALTH SERVICES TECH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMDT (CG-1122), U.S. COAST GUARD 2100 2ND ST SW, SUITE 5314
WASHINGTON DC
20593-0001
US

IV. Provider business mailing address

5111 152ND AVENUE CT E
SUMNER WA
98390-3208
US

V. Phone/Fax

Practice location:
  • Phone: 206-217-6290
  • Fax:
Mailing address:
  • Phone: 253-891-1838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: