Healthcare Provider Details

I. General information

NPI: 1689744534
Provider Name (Legal Business Name): TANASSE CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 CLEVELAND AVE SE SUITE D
TUMWATER WA
98501-3342
US

IV. Provider business mailing address

344 CLEVELAND AVE SE SUITE D
TUMWATER WA
98501-3342
US

V. Phone/Fax

Practice location:
  • Phone: 360-357-5170
  • Fax: 360-357-5173
Mailing address:
  • Phone: 360-357-5170
  • Fax: 360-357-5173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH00033999
License Number StateWA

VIII. Authorized Official

Name: DR. JOHN FRANCIS TANASSE
Title or Position: OFFICER, OWNER
Credential: D.C.
Phone: 360-357-5170