Provider Demographics
NPI:1801041876
Name:DR. WILLIAM G. DEDGE, DC, INC., PS
Entity Type:Organization
Organization Name:DR. WILLIAM G. DEDGE, DC, INC., PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:DEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-939-9599
Mailing Address - Street 1:721 M ST NE
Mailing Address - Street 2:STE 105
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4503
Mailing Address - Country:US
Mailing Address - Phone:253-939-9599
Mailing Address - Fax:253-804-5655
Practice Address - Street 1:721 M ST NE
Practice Address - Street 2:STE 105
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4503
Practice Address - Country:US
Practice Address - Phone:253-939-9599
Practice Address - Fax:253-804-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center