Provider Demographics
NPI:1669537718
Name:KENDRICK, PAUL LESLIE (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LESLIE
Last Name:KENDRICK
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 1:719 S LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6020
Mailing Address - Country:US
Mailing Address - Phone:360-457-8292
Mailing Address - Fax:360-457-8274
Practice Address - Street 1:719 S LAUREL ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6020
Practice Address - Country:US
Practice Address - Phone:360-457-8292
Practice Address - Fax:360-457-8274
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002641111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0049949OtherLABOR & INDUSTRIES
WA0049949OtherLABOR & INDUSTRIES