MEDICARE: DR. WILLIAM LANCE EBLEN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH00002018	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	350011531	OTHER		RAILROAD MEDICARE
4	G8904624	OTHER	WA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0026590	OTHER	WA	WORKERS COMP
2	CH00002018	OTHER	WA	WASH STATE

General Provider Information

NPI Number	:	1396851069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM LANCE EBLEN DC

Provider Business Mailing Address
First Line	:	PO BOX 997
Second Line	:
City	:	MONROE
State	:	WA
Zip	:	98272-0997
Country	:	US
Telephone Number	:	360-794-7115
Fax Number	:	360-794-7114

Provider Business Practice Location Address
First Line	:	1233 W MAIN ST
Second Line	:
City	:	MONROE
State	:	WA
Zip	:	98272-2028
Country	:	US
Telephone Number	:	360-794-7115
Fax Number	:	360-794-7114

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	06/06/2012

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Directions to “ DR. WILLIAM LANCE EBLEN DC” Practice Location

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