Provider Demographics
NPI:1144699190
Name:EDMARK CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:EDMARK CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:A
Authorized Official - Last Name:EDMARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-397-4900
Mailing Address - Street 1:10519 20TH ST SE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-4768
Mailing Address - Country:US
Mailing Address - Phone:425-397-4900
Mailing Address - Fax:425-397-6900
Practice Address - Street 1:10519 20TH ST SE
Practice Address - Street 2:SUITE 1
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-4768
Practice Address - Country:US
Practice Address - Phone:425-397-4900
Practice Address - Fax:425-397-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA001200971Medicare PIN