Provider Demographics
NPI:1265569198
Name:BEDELL, LESLIE (DC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:BEDELL
Suffix:
Gender:F
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:PO BOX 1219
Mailing Address - Street 2:145 E. THIRD STREET
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-1219
Mailing Address - Country:US
Mailing Address - Phone:425-888-1670
Mailing Address - Fax:
Practice Address - Street 1:145 E 3RD ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8144
Practice Address - Country:US
Practice Address - Phone:425-888-1670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA62686OtherLABOR AND INDUSTRIES
WA62686OtherLABOR AND INDUSTRIES