Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH00034577 | WA |
NPI | 1790790236 |
---|---|
Provider Name | Dr. Brad M Mundt |
First Address | Tacoma, WA 98408-7031 |
Second Address | Tacoma, WA 98408-7031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 27/07/2015 |