Provider Demographics
NPI:1659578516
Name:TUMWATER CHIROPRACTIC CENTER PS
Entity Type:Organization
Organization Name:TUMWATER CHIROPRACTIC CENTER PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGRET
Authorized Official - Middle Name:MOREEN
Authorized Official - Last Name:WUNSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-570-9580
Mailing Address - Street 1:128 D ST SW STE A
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4064
Mailing Address - Country:US
Mailing Address - Phone:360-570-9580
Mailing Address - Fax:360-570-9583
Practice Address - Street 1:128 D ST SW STE A
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-4064
Practice Address - Country:US
Practice Address - Phone:360-570-9580
Practice Address - Fax:360-570-9583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0023427OtherDEPT OF L&I
WAG8856480Medicare ID - Type UnspecifiedMEDICARE