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TACOMA MALL CHIROPRACTIC, PLLC

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Company Details

Legal Name: TACOMA MALL CHIROPRACTIC, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Administratively Dissolved
Formation/ Registration Date: October 21st 2011
Date of Dissolution: May 1st 2017
Expiration date: 31 Oct 2016
UBI Number: 603 153 274

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Registered Agent Information

Name Role Address
ISLAM WARDAK Registered Agent 2115 S 56TH ST #101, TACOMA, WA, 98409-0000, UNITED STATES

Key Officers & Management

Name Role Address
ISLAM WARDAK Governing Person 4703 219TH ST SW, MOUNTLAKE TERRACE, WA, 98043, UNITED STATES

National Provider Identifier

NPI Number:
1548844749
Certification Date:
2021-05-12

Authorized Person:

Name:
NADIM HALABI
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
111N00000X - Chiropractor
Is Primary:
No
Selected Taxonomy:
225700000X - Massage Therapist
Is Primary:
No
Selected Taxonomy:
111NR0200X - Radiology Chiropractor
Is Primary:
Yes

Contacts:

Fax:
2532671405
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