=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619247293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMDE CHIROPRACTIC PS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2012
-----------------------------------------------------
Last Update Date | 01/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2017 CONTINENTAL PL SUITE 1
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98273-5649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-424-3900
-----------------------------------------------------
Fax | 360-424-3900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2017 CONTINENTAL PL SUITE 1
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98273-5649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-424-3900
-----------------------------------------------------
Fax | 360-424-3900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOHN W EMDE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 360-424-3900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2678
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------