Provider Demographics
NPI:1457427254
Name:EMDE, JOHN W (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:EMDE
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 1:17400 LITTLE MOUNTAIN PLACE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274
Mailing Address - Country:US
Mailing Address - Phone:360-422-5051
Mailing Address - Fax:
Practice Address - Street 1:2017 CONTINENTAL PL
Practice Address - Street 2:SUITE 1
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5649
Practice Address - Country:US
Practice Address - Phone:360-424-3900
Practice Address - Fax:360-424-3900
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAEM8970OtherBLUE CROSS BLUE SHIELD
WA2687OtherCHIROPRACTIC LICENSE
WA91-1575469OtherTAX ID #
WA34896OtherLABOR & INDUSRIES
WA601 428 238 001 0002OtherUBI #
WA91-1575469OtherTAX ID #