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General NPI Number Information
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NPI Number | 1366591331
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Entity Type | Organization
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Legal Business Name | THOMAS G REARDON D.C. P.S.
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 1717 NE 44TH ST SUITE G
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City | RENTON
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State | WA
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Zip | 98056-9001
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Country | US
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Telephone | 425-277-4098
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Fax | 425-277-8239
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Provider Business Mailing Address
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Address Line | 1717 NE 44TH ST SUITE G
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City | RENTON
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State | WA
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Zip | 98056-9001
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Country | US
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Telephone | 425-277-4098
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Fax | 425-277-8239
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Authorized Official
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Title or Position | P.S.
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Name | THOMAS REARDON
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Credential | D.C.
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Telephone | 425-277-4098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH00002695
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License Number State | WA
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