Provider Demographics
NPI:1821172156
Name:CHESNUTIS, EDWARD JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:CHESNUTIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10305 19TH AVE SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4218
Mailing Address - Country:US
Mailing Address - Phone:425-379-9999
Mailing Address - Fax:425-741-2042
Practice Address - Street 1:10305 19TH AVE SE
Practice Address - Street 2:SUITE A
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4218
Practice Address - Country:US
Practice Address - Phone:425-379-9999
Practice Address - Fax:425-741-2042
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000322213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA912094956OtherPRIVATE INSURANCE
WA0179830OtherIME
WA480003568OtherRAILROAD MEDICARE
WA4810770001OtherCIGNA MEDICARE DMERC
WACH9020OtherREGENCE
WA9054040OtherDSHS DME
WA1386804Medicaid
WA65650OtherDEPARTMENT OF L&I
WA9054040OtherDSHS DME
WACH9020OtherREGENCE