Provider Demographics
NPI:1043323249
Name:OWENS, EDWARD ALEXANDER (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALEXANDER
Last Name:OWENS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1238
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009-1238
Mailing Address - Country:US
Mailing Address - Phone:425-802-5432
Mailing Address - Fax:855-237-3755
Practice Address - Street 1:13400 NE 20TH STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2056
Practice Address - Country:US
Practice Address - Phone:425-802-5432
Practice Address - Fax:855-237-3755
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH3420111N00000X
WACH00003420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB12905Medicare ID - Type Unspecified