Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 27-3241 | OR |
N | 111NS0005X | Chiropractic Sports Physician | 27-3241 | OR |
N | 175F00000X | Naturopath | 1062 | OR |
NPI | 1114043247 |
---|---|
Provider Name | Dr. Edward Payson Flattery |
First Address | Bend, OR 97701-4387 |
Second Address | Bend, OR 97701-4387 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U80302 | (02) | OR |