Healthcare Provider Details

I. General information

NPI: 1790790236
Provider Name (Legal Business Name): BRAD M MUNDT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 PACIFIC AVE
TACOMA WA
98408-7031
US

IV. Provider business mailing address

7910 PACIFIC AVE
TACOMA WA
98408-7031
US

V. Phone/Fax

Practice location:
  • Phone: 253-473-3733
  • Fax:
Mailing address:
  • Phone: 253-473-3733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH00034577
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: