Provider Demographics
NPI:1821151820
Name:CORLEY, EDWARD D (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:D
Last Name:CORLEY
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 1:4114 BRIDGEPORT WAY WEST
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466
Mailing Address - Country:US
Mailing Address - Phone:253-564-8100
Mailing Address - Fax:253-564-8387
Practice Address - Street 1:4114 BRIDGEPORT WAY WEST
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466
Practice Address - Country:US
Practice Address - Phone:253-564-8100
Practice Address - Fax:253-564-8387
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003648111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACO5411OtherREGENCE