MEDICARE: DR. J BRIAN ADDLEMAN D.C.

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	CH00001646	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	350003021	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17992	OTHER	WA	DLI

General Provider Information

NPI Number	:	1942330758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. J BRIAN ADDLEMAN D.C.

Provider Business Mailing Address
First Line	:	100 VALLEY MALL PKWY
Second Line	:	SUITE 5
City	:	EAST WENATCHEE
State	:	WA
Zip	:	98802-5348
Country	:	US
Telephone Number	:	509-884-3368
Fax Number	:	509-884-4720

Provider Business Practice Location Address
First Line	:	100 VALLEY MALL PKWY
Second Line	:	SUITE 5
City	:	EAST WENATCHEE
State	:	WA
Zip	:	98802-5348
Country	:	US
Telephone Number	:	509-884-3368
Fax Number	:	509-884-4720

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	07/09/2007

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