Provider Demographics
NPI:1689744534
Name:TANASSE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:TANASSE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:TANASSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-357-5170
Mailing Address - Street 1:344 CLEVELAND AVE SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3342
Mailing Address - Country:US
Mailing Address - Phone:360-357-5170
Mailing Address - Fax:360-357-5173
Practice Address - Street 1:344 CLEVELAND AVE SE
Practice Address - Street 2:SUITE D
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-3342
Practice Address - Country:US
Practice Address - Phone:360-357-5170
Practice Address - Fax:360-357-5173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033999111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0151745OtherWORKER'S COMPENSATION, WA
WA0151745OtherWORKER'S COMPENSATION, WA