Healthcare Provider Details

I. General information

NPI: 1659919249
Provider Name (Legal Business Name): MOVEMENT CHIROPRACTIC AND MASSAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2019
Last Update Date: 12/14/2019
Certification Date: 12/14/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 HUNT AVE
SUMNER WA
98390-1117
US

IV. Provider business mailing address

603 HUNT AVE
SUMNER WA
98390-1117
US

V. Phone/Fax

Practice location:
  • Phone: 253-863-0855
  • Fax: 253-826-0511
Mailing address:
  • Phone: 253-863-0855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JORDAN SCOTT THAANUM
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 253-820-7746