Provider Demographics
NPI:1760566012
Name:WELCH, EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:WELCH
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 1:1103 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1421
Mailing Address - Country:US
Mailing Address - Phone:541-479-1982
Mailing Address - Fax:541-479-0621
Practice Address - Street 1:1103 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1421
Practice Address - Country:US
Practice Address - Phone:541-479-1982
Practice Address - Fax:541-479-0621
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-1547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR115703Medicare PIN
ORT68249Medicare UPIN