Provider Demographics
NPI:1982752275
Name:DEDGE, WILLIAM G (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:G
Last Name:DEDGE
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 1:721 M ST NE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4503
Mailing Address - Country:US
Mailing Address - Phone:253-939-9599
Mailing Address - Fax:253-804-5655
Practice Address - Street 1:721 M ST NE
Practice Address - Street 2:SUITE 105
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4503
Practice Address - Country:US
Practice Address - Phone:253-939-9599
Practice Address - Fax:253-804-5655
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002488111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU17909Medicare UPIN
WAGAB24098Medicare ID - Type Unspecified