Provider Demographics
NPI:1710198999
Name:PORT TOWNSEND CHIROPRACTIC CENTER, PS
Entity Type:Organization
Organization Name:PORT TOWNSEND CHIROPRACTIC CENTER, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEDNARZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-379-0800
Mailing Address - Street 1:2041 E SIMS WAY
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-6905
Mailing Address - Country:US
Mailing Address - Phone:360-379-0800
Mailing Address - Fax:
Practice Address - Street 1:2041 E SIMS WAY
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6905
Practice Address - Country:US
Practice Address - Phone:360-379-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH0003295111N00000X
WAMA00016240225700000X
WAMA00016328225700000X
WAMA00020718225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2024271Medicaid
WA8935706OtherL&I CRIME VICTIMS
WA121526OtherL&I GROUP
WABE9838OtherWA REGENCE
WA121526OtherL&I GROUP
WA2024271Medicaid
WAU66924Medicare UPIN
WA121526OtherL&I GROUP