Provider Demographics
NPI:1023247376
Name:PACIFIC MEDICAL & CHIROPRACTIC, P.S.
Entity type:Organization
Organization Name:PACIFIC MEDICAL & CHIROPRACTIC, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ND
Authorized Official - Phone:253-584-1144
Mailing Address - Street 1:8909 GRAVELLY LAKE DR SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3101
Mailing Address - Country:US
Mailing Address - Phone:253-584-1144
Mailing Address - Fax:253-588-5060
Practice Address - Street 1:8909 GRAVELLY LAKE DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3101
Practice Address - Country:US
Practice Address - Phone:253-584-1144
Practice Address - Fax:253-588-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00002085111N00000X
WA00000558175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty