Provider Demographics
NPI:1306299458
Name:THOELKE, ROSS M (DC)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:M
Last Name:THOELKE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8033 W GRANDRIDGE BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7159
Mailing Address - Country:US
Mailing Address - Phone:509-783-1899
Mailing Address - Fax:509-783-1898
Practice Address - Street 1:8033 W GRANDRIDGE BLVD
Practice Address - Street 2:STE C
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7159
Practice Address - Country:US
Practice Address - Phone:509-783-1899
Practice Address - Fax:509-783-1898
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60661742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor