Provider Demographics
NPI:1194861070
Name:VOSS, EDWARD CHARLES (DC)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:CHARLES
Last Name:VOSS
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:PO BOX 988
Mailing Address - Street 2:10107 213TH ST EAST
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-0988
Mailing Address - Country:US
Mailing Address - Phone:253-847-2687
Mailing Address - Fax:253-846-3012
Practice Address - Street 1:10107 213TH ST E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-0988
Practice Address - Country:US
Practice Address - Phone:253-847-2687
Practice Address - Fax:253-846-3012
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002377111NI0013X, 111NR0200X, 111NR0400X, 111NS0005X, 111NX0100X, 111NX0800X
WACH0000237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA26528OtherL&I
WA26528OtherLABOR & INDUSTRIES
WA8852711Medicare ID - Type Unspecified
WA26528OtherL&I
T86911Medicare UPIN
WA26528OtherLABOR & INDUSTRIES