Healthcare Provider Details

I. General information

NPI: 1609053818
Provider Name (Legal Business Name): MARK L WEBB DC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 PACIFIC AVE
TACOMA WA
98408
US

IV. Provider business mailing address

6201 PACIFIC AVE
TACOMA WA
98408
US

V. Phone/Fax

Practice location:
  • Phone: 253-472-9669
  • Fax: 253-473-2904
Mailing address:
  • Phone: 253-472-9669
  • Fax: 253-473-2904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHOOOO1639
License Number StateWA

VIII. Authorized Official

Name: MARK L WEBB
Title or Position: OWNER DOCTOR
Credential: DC
Phone: 253-472-9669