Provider Demographics
NPI:1144851296
Name:CANDIDO, EDGAR (DC)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:
Last Name:CANDIDO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 MINOR CT
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98930-4800
Mailing Address - Country:US
Mailing Address - Phone:509-305-7808
Mailing Address - Fax:
Practice Address - Street 1:1211 MINOR CT
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-4800
Practice Address - Country:US
Practice Address - Phone:509-305-7808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61035343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor