Provider Demographics
NPI:1073931275
Name:CHESNUTIS, EDWARD III (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:CHESNUTIS
Suffix:III
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10305 19TH AVE SE
Mailing Address - Street 2:STE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4252
Mailing Address - Country:US
Mailing Address - Phone:425-379-9999
Mailing Address - Fax:425-585-0031
Practice Address - Street 1:1721 E 19TH AVE STE 520
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1243
Practice Address - Country:US
Practice Address - Phone:303-839-6741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAPO60757497213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program