MEDICARE: MR. CHAD ERIC TRIPLETT L.M.P.

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	174400000X	Specialist	MA0001093	WA

General Provider Information

NPI Number	:	1346398823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHAD ERIC TRIPLETT L.M.P.

Provider Business Mailing Address
First Line	:	3501 SHELBY RD
Second Line	:	SUITE C
City	:	LYNNWOOD
State	:	WA
Zip	:	98087-3599
Country	:	US
Telephone Number	:	425-745-9052
Fax Number	:	425-745-3372

Provider Business Practice Location Address
First Line	:	3501 SHELBY RD
Second Line	:	SUITE C
City	:	LYNNWOOD
State	:	WA
Zip	:	98087-3599
Country	:	US
Telephone Number	:	425-745-9052
Fax Number	:	425-745-3372

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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