Provider Demographics
NPI:1396851069
Name:EBLEN, WILLIAM LANCE (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LANCE
Last Name:EBLEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:W
Other - Middle Name:LANCE
Other - Last Name:EBLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-0997
Mailing Address - Country:US
Mailing Address - Phone:360-794-7115
Mailing Address - Fax:360-794-7114
Practice Address - Street 1:1233 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2028
Practice Address - Country:US
Practice Address - Phone:360-794-7115
Practice Address - Fax:360-794-7114
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002018111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0026590OtherWORKERS COMP
WACH00002018OtherWASH STATE
350011531OtherRAILROAD MEDICARE
WAG8904624OtherMEDICARE PTAN
WAG8904624OtherMEDICARE PTAN