Provider Demographics
NPI:1336466879
Name:EDWARD J CHESNUTIS, DPM, PLLC
Entity Type:Organization
Organization Name:EDWARD J CHESNUTIS, DPM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHESNUTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:425-379-9999
Mailing Address - Street 1:10305 19TH AVE SE STE A
Mailing Address - Street 2:
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:425-741-2042
Practice Address - Street 1:10305 19TH AVE SE STE A
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4252
Practice Address - Country:US
Practice Address - Phone:425-379-9999
Practice Address - Fax:425-741-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602086598332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies