Provider Demographics
NPI:1265890941
Name:KENT TACOMA CHIROPRACTIC
Entity type:Organization
Organization Name:KENT TACOMA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HALABI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-520-2529
Mailing Address - Street 1:PO BOX 5669
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98064-5669
Mailing Address - Country:US
Mailing Address - Phone:253-520-2529
Mailing Address - Fax:253-852-4453
Practice Address - Street 1:24612 104TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-4965
Practice Address - Country:US
Practice Address - Phone:253-520-2529
Practice Address - Fax:253-852-4453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60534560225700000X
WACH00002970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty