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General NPI Number Information
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NPI Number | 1770865990
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Entity Type | Organization
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Legal Business Name | AGAPE CHIROPRACTIC HEALING CENTER, P.S.
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | 145 E 3RD ST
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City | NORTH BEND
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State | WA
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Zip | 98045-8144
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Country | US
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Telephone | 425-888-1670
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Fax | 425-831-2170
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Provider Business Mailing Address
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Address Line | PO BOX 1219
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City | NORTH BEND
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State | WA
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Zip | 98045-1219
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Country | US
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Telephone | 425-888-1670
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Fax | 425-831-2170
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. LESLIE BEDELL
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Credential | D.C.
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Telephone | 425-888-1670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2162
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License Number State | WA
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