Provider Demographics
NPI:1609095835
Name:CHAN, DAVID W (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:CHAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4339 W KENNEWICK AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2802
Mailing Address - Country:US
Mailing Address - Phone:509-735-0311
Mailing Address - Fax:509-783-1206
Practice Address - Street 1:4339 W KENNEWICK AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2802
Practice Address - Country:US
Practice Address - Phone:509-735-0311
Practice Address - Fax:509-783-1206
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0116689OtherDEPARTMENT OF L AND I
WAT86882Medicare UPIN
WAGAB01982Medicare PIN