Provider Demographics
NPI:1619247293
Name:EMDE CHIROPRACTIC PS
Entity Type:Organization
Organization Name:EMDE CHIROPRACTIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:EMDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-424-3900
Mailing Address - Street 1:2017 CONTINENTAL PL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-5649
Mailing Address - Country:US
Mailing Address - Phone:360-424-3900
Mailing Address - Fax:360-424-3900
Practice Address - Street 1:2017 CONTINENTAL PL
Practice Address - Street 2:SUITE 1
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5649
Practice Address - Country:US
Practice Address - Phone:360-424-3900
Practice Address - Fax:360-424-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA34896OtherLABOR & INDUSTRIES
WAEM8970OtherBLUE CROSS BLUE SHILD
WAEM8970OtherBLUE CROSS BLUE SHILD