Provider Demographics
NPI:1720019342
Name:PADDOCK, DONALD SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:SCOTT
Last Name:PADDOCK
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 1:6720 E SIDE DR NE
Mailing Address - Street 2:STE #2
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-1174
Mailing Address - Country:US
Mailing Address - Phone:253-927-9325
Mailing Address - Fax:253-927-9221
Practice Address - Street 1:6720 E SIDE DR NE
Practice Address - Street 2:STE #2
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-1174
Practice Address - Country:US
Practice Address - Phone:253-927-9325
Practice Address - Fax:253-927-9221
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB38564Medicare ID - Type Unspecified