Provider Demographics
NPI:1962694224
Name:THOMAS WAYNE PLLC
Entity type:Organization
Organization Name:THOMAS WAYNE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MANCHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-838-0022
Mailing Address - Street 1:15858 1ST AVENUE SOUTH
Mailing Address - Street 2:SUITE #A104
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148
Mailing Address - Country:US
Mailing Address - Phone:206-838-0022
Mailing Address - Fax:206-838-0021
Practice Address - Street 1:15858 1ST AVENUE SOUTH
Practice Address - Street 2:SUITE #A104
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148
Practice Address - Country:US
Practice Address - Phone:206-838-0022
Practice Address - Fax:206-838-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034652111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty