Provider Demographics
NPI:1609907351
Name:TANNER, ALLEN BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:BRIAN
Last Name:TANNER
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 1:3027 S 224TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-5135
Mailing Address - Country:US
Mailing Address - Phone:206-878-8124
Mailing Address - Fax:206-878-8509
Practice Address - Street 1:3027 S 224TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-5135
Practice Address - Country:US
Practice Address - Phone:206-878-8124
Practice Address - Fax:206-878-8509
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor