Provider Demographics
NPI:1861916488
Name:TACOMA CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:TACOMA CHIROPRACTIC CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANOTON
Authorized Official - Last Name:STALDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-759-1500
Mailing Address - Street 1:2705 NE 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7129
Mailing Address - Country:US
Mailing Address - Phone:206-523-9000
Mailing Address - Fax:206-523-5566
Practice Address - Street 1:2705 NE 65TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-7129
Practice Address - Country:US
Practice Address - Phone:206-523-9000
Practice Address - Fax:206-523-5566
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TACOMA CHIROPRACTIC CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty