Provider Demographics
NPI:1548341670
Name:TANASSE, JOHN (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:TANASSE
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 1:344 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
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033999111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0151745OtherWORKER'S COMP PROVIDER #
WAU86180Medicare UPIN
WAGAB37883Medicare PIN