Provider Demographics
NPI:1033386818
Name:TACOMA FAMILY CHIROPRACTIC INC., P.S.
Entity Type:Organization
Organization Name:TACOMA FAMILY CHIROPRACTIC INC., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:STOCKTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-474-9670
Mailing Address - Street 1:1033 N TACOMA AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-2928
Mailing Address - Country:US
Mailing Address - Phone:253-474-9670
Mailing Address - Fax:253-474-9692
Practice Address - Street 1:1033 N TACOMA AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-2928
Practice Address - Country:US
Practice Address - Phone:253-474-9670
Practice Address - Fax:253-474-9692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB13104Medicare UPIN