MEDICARE: EDMARK CHIROPRACTIC PLLC

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	CH00002100	WA

General Provider Information

NPI Number	:	1144699190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDMARK CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	10519 20TH ST SE
Second Line	:	SUITE 1
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-4768
Country	:	US
Telephone Number	:	425-397-4900
Fax Number	:	425-397-6900

Provider Business Practice Location Address
First Line	:	10519 20TH ST SE
Second Line	:	SUITE 1
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-4768
Country	:	US
Telephone Number	:	425-397-4900
Fax Number	:	425-397-6900

Authorized Official
Title or Position	:	OWNER
Name	:	KURT A EDMARK
Credential	:	D.C.
Telephone Number	:	425-397-4900

Provider Enumeration Date	:	09/21/2015
Last Update Date	:	09/21/2015

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