Provider Demographics
NPI:1073653374
Name:VELICKOFF, THOMAS ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANTHONY
Last Name:VELICKOFF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:VELICKOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:6839 S K ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-3121
Mailing Address - Country:US
Mailing Address - Phone:360-903-6825
Mailing Address - Fax:
Practice Address - Street 1:601 S PINE ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2793
Practice Address - Country:US
Practice Address - Phone:360-903-6825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor