Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH00002641 | WA |
NPI | 1669537718 |
---|---|
Provider Name | Dr. Paul Leslie Kendrick |
First Address | Port Angeles, WA 98362-6020 |
Second Address | Port Angeles, WA 98362-6020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 12/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0049949 | LABOR & INDUSTRIES (01) | WA |
GAB36216 | (02) | WA |