Provider Demographics
NPI:1457422727
Name:PADELFORD, PHILLIP M (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:M
Last Name:PADELFORD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:PHILLIP
Other - Middle Name:M
Other - Last Name:PADELFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 73575
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0575
Mailing Address - Country:US
Mailing Address - Phone:253-848-6626
Mailing Address - Fax:253-848-6937
Practice Address - Street 1:609 39TH AVE SW
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-5917
Practice Address - Country:US
Practice Address - Phone:253-848-6626
Practice Address - Fax:253-848-6937
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001161111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA30383OtherLABOR & INDUSTRY ID #
WA5882PAMedicare UPIN
WAT02768Medicare UPIN
WAG8903481Medicare UPIN
WA001000877Medicare ID - Type UnspecifiedMC ID #