Provider Demographics
NPI:1922211663
Name:BEDLINGTON CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:BEDLINGTON CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:ALDEN
Authorized Official - Last Name:BEDLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-966-5844
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:211 E MAIN ST
Mailing Address - City:EVERSON
Mailing Address - State:WA
Mailing Address - Zip Code:98247-0160
Mailing Address - Country:US
Mailing Address - Phone:360-966-5844
Mailing Address - Fax:360-966-7718
Practice Address - Street 1:211 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EVERSON
Practice Address - State:WA
Practice Address - Zip Code:98247-0160
Practice Address - Country:US
Practice Address - Phone:360-966-5844
Practice Address - Fax:360-966-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2016178Medicaid
WA602018128OtherUBI
WA2016178Medicaid