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General NPI Number Information
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NPI Number | 1982752275
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Entity Type | Individual
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Provider Name | WILLIAM G. DEDGE DC
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Gender | Male
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 12/20/2012
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Provider Practice Location Address
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Address Line | 721 M ST NE SUITE 105
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City | AUBURN
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State | WA
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Zip | 98002-4503
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Country | US
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Telephone | 253-939-9599
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Fax | 253-804-5655
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Provider Business Mailing Address
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Address Line | 721 M ST NE SUITE 105
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City | AUBURN
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State | WA
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Zip | 98002-4503
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Country | US
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Telephone | 253-939-9599
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Fax | 253-804-5655
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | CH00002488
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License Number State | WA
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