Provider Demographics
NPI:1114043247
Name:FLATTERY, EDWARD PAYSON (ND,DC,PC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:PAYSON
Last Name:FLATTERY
Suffix:
Gender:M
Credentials:ND,DC,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 NE NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4387
Mailing Address - Country:US
Mailing Address - Phone:541-322-3358
Mailing Address - Fax:541-322-3359
Practice Address - Street 1:464 NE NORTON AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4387
Practice Address - Country:US
Practice Address - Phone:541-323-3358
Practice Address - Fax:541-323-3358
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-3241111NS0005X, 111N00000X
OR1062175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR132902Medicare ID - Type UnspecifiedGROUP NUMBER
ORU80302Medicare UPIN
OR132901Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE