MEDICARE: DR. PAUL LESLIE KENDRICK DC

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	111NX0800X	Orthopedic Chiropractor	CH00002641	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0049949	OTHER	WA	LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1669537718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL LESLIE KENDRICK DC

Provider Business Mailing Address
First Line	:	719 S LAUREL ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-6020
Country	:	US
Telephone Number	:	360-457-8292
Fax Number	:	360-457-8274

Provider Business Practice Location Address
First Line	:	719 S LAUREL ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-6020
Country	:	US
Telephone Number	:	360-457-8292
Fax Number	:	360-457-8274

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	02/12/2008

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