Healthcare Provider Details

I. General information

NPI: 1215492079
Provider Name (Legal Business Name): MICHAEL T DONE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 PACIFIC AVE
TACOMA WA
98408-7624
US

IV. Provider business mailing address

5220 PACIFIC AVE
TACOMA WA
98408-7624
US

V. Phone/Fax

Practice location:
  • Phone: 253-472-3365
  • Fax: 253-472-3384
Mailing address:
  • Phone: 253-472-3365
  • Fax: 253-472-3384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number60924701
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: