Provider Demographics
NPI:1396820536
Name:FARLEY, CHAD (DPM)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:FARLEY
Suffix:
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 1:11307 BRIDGEPORT WAY SW
Mailing Address - Street 2:STE 220A
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3024
Mailing Address - Country:US
Mailing Address - Phone:253-985-2733
Mailing Address - Fax:253-985-3868
Practice Address - Street 1:11307 BRIDGEPORT WAY SW
Practice Address - Street 2:STE 220A
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3024
Practice Address - Country:US
Practice Address - Phone:253-985-2733
Practice Address - Fax:253-985-3868
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000731213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00345477OtherRAILROAD
WA0219604OtherL & I
WA203641OtherL & I
WA8940615OtherCRIME VICTIMS
WA8944020OtherCRIME VICTIMS
WA8441636Medicaid
WAP00345477OtherRAILROAD
WAG8864568Medicare PIN
WA0219604OtherL & I