Provider Demographics
NPI:1851793467
Name:TACOMA WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:TACOMA WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMON
Authorized Official - Middle Name:
Authorized Official - Last Name:KOONER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-473-3733
Mailing Address - Street 1:7910 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-7031
Mailing Address - Country:US
Mailing Address - Phone:253-473-3733
Mailing Address - Fax:
Practice Address - Street 1:7910 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7031
Practice Address - Country:US
Practice Address - Phone:253-473-3733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty