Provider Demographics
NPI:1619983210
Name:PAUL, DAVID ALLEN (DC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLEN
Last Name:PAUL
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:PO BOX 3698
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-5052
Mailing Address - Country:US
Mailing Address - Phone:360-683-2225
Mailing Address - Fax:360-582-9637
Practice Address - Street 1:625 N 5TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-5062
Practice Address - Country:US
Practice Address - Phone:360-683-2225
Practice Address - Fax:360-582-9637
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003556111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA120946OtherL&I PROVIDER ID
WAGAB03239Medicare ID - Type UnspecifiedPROVIDER ID
WA1619983210Medicare UPIN