Provider Demographics
NPI:1619274123
Name:CHAND, EDWARD (MT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:CHAND
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9921 NE 116TH ST
Mailing Address - Street 2:APT 13
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4237
Mailing Address - Country:US
Mailing Address - Phone:209-298-6256
Mailing Address - Fax:
Practice Address - Street 1:9921 NE 116TH ST
Practice Address - Street 2:APT 13
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4237
Practice Address - Country:US
Practice Address - Phone:209-298-6256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60203288225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist