Provider Demographics
NPI:1114480191
Name:DEVINE, TASHAUNA RAE (DC)
Entity Type:Individual
Prefix:DR
First Name:TASHAUNA
Middle Name:RAE
Last Name:DEVINE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 S DIVISION ST APT 122
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-3251
Mailing Address - Country:US
Mailing Address - Phone:509-431-3553
Mailing Address - Fax:
Practice Address - Street 1:1519 BASIN ST SW
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-2135
Practice Address - Country:US
Practice Address - Phone:509-431-3553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60946902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor