Provider Demographics
NPI:1790861482
Name:TSE, THOMAS C (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:TSE
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 1:4346 15TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1446
Mailing Address - Country:US
Mailing Address - Phone:206-763-0600
Mailing Address - Fax:206-763-0601
Practice Address - Street 1:4346 15TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1446
Practice Address - Country:US
Practice Address - Phone:206-763-0600
Practice Address - Fax:206-763-0601
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA33520OtherL&I
WA2012664Medicaid
WAU20851Medicare UPIN