=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922211663
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEDLINGTON CHIROPRACTIC CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2007
-----------------------------------------------------
Last Update Date | 10/06/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 E MAIN ST
-----------------------------------------------------
City | EVERSON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98247-0160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-966-5844
-----------------------------------------------------
Fax | 360-966-7718
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 160 211 E MAIN ST
-----------------------------------------------------
City | EVERSON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98247-0160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-966-5844
-----------------------------------------------------
Fax | 360-966-7718
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO DOCTOR
-----------------------------------------------------
Name | MR. RAYMOND ALDEN BEDLINGTON
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 360-966-5844
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH00002655
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------