Provider Demographics
NPI:1366591331
Name:THOMAS G REARDON D.C. P.S.
Entity type:Organization
Organization Name:THOMAS G REARDON D.C. P.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:P.S.
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:REARDON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-277-4098
Mailing Address - Street 1:1717 NE 44TH ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-9001
Mailing Address - Country:US
Mailing Address - Phone:425-277-4098
Mailing Address - Fax:425-277-8239
Practice Address - Street 1:1717 NE 44TH ST
Practice Address - Street 2:SUITE G
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-9001
Practice Address - Country:US
Practice Address - Phone:425-277-4098
Practice Address - Fax:425-277-8239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARE2839OtherREGENCE BLUE SHIELD
WA39743OtherDEP. OF L & I
WAU43787Medicare UPIN