Provider Demographics
NPI:1710121322
Name:TACOMA CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:TACOMA CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:STALDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-281-1594
Mailing Address - Street 1:2611 N STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-4670
Mailing Address - Country:US
Mailing Address - Phone:253-759-1500
Mailing Address - Fax:253-759-4172
Practice Address - Street 1:2611 N STEVENS ST
Practice Address - Street 2:STE 230
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-4670
Practice Address - Country:US
Practice Address - Phone:253-759-1500
Practice Address - Fax:253-759-4172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty