Provider Demographics
NPI:1801851852
Name:WEST, EDWARD L (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:L
Last Name:WEST
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 1:6314 19TH ST WEST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6223
Mailing Address - Country:US
Mailing Address - Phone:253-564-9092
Mailing Address - Fax:253-565-9045
Practice Address - Street 1:6314 19TH ST W
Practice Address - Street 2:SUITE 11
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6223
Practice Address - Country:US
Practice Address - Phone:253-564-9092
Practice Address - Fax:253-565-9045
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1801851852Medicaid
WV0016752OtherDEPT OF LABOR & INDUSTRIES
WA001001300Medicare ID - Type Unspecified
WATO2820Medicare UPIN