Healthcare Provider Details

I. General information

NPI: 1861916488
Provider Name (Legal Business Name): TACOMA CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 NE 65TH ST
SEATTLE WA
98115-7129
US

IV. Provider business mailing address

2705 NE 65TH ST
SEATTLE WA
98115-7129
US

V. Phone/Fax

Practice location:
  • Phone: 206-523-9000
  • Fax: 206-523-5566
Mailing address:
  • Phone: 206-523-9000
  • Fax: 206-523-5566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateWA

VIII. Authorized Official

Name: DR. ROBERT ANOTON STALDER
Title or Position: OWNER
Credential: DC
Phone: 253-759-1500