Provider Demographics
NPI:1407254311
Name:THAANUM, JORDAN S (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:S
Last Name:THAANUM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 HUNT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-1117
Mailing Address - Country:US
Mailing Address - Phone:253-863-0855
Mailing Address - Fax:253-826-0511
Practice Address - Street 1:603 HUNT AVE STE A
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1117
Practice Address - Country:US
Practice Address - Phone:253-863-0855
Practice Address - Fax:253-826-0511
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60506347111N00000X
WACH60506347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor