Provider Demographics
NPI:1235494139
Name:TALBURT, THOMAS DUAYNE (DC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:DUAYNE
Last Name:TALBURT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:THOMAS
Other - Middle Name:DUAYNE
Other - Last Name:TALBURT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:11031 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98168-1704
Mailing Address - Country:US
Mailing Address - Phone:206-550-3615
Mailing Address - Fax:
Practice Address - Street 1:11031 14TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98168-1704
Practice Address - Country:US
Practice Address - Phone:206-550-3615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-07
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60282072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACH 60282072OtherWASHINGTON STATE DEPARTMENT OF HEALTH