Provider Demographics
NPI:1699733667
Name:FEARN, PAUL W (DC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:FEARN
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 1:19206 SE 1ST. ST #118
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2603
Mailing Address - Country:US
Mailing Address - Phone:360-834-6964
Mailing Address - Fax:
Practice Address - Street 1:19206 SE 1ST ST STE 118
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7478
Practice Address - Country:US
Practice Address - Phone:360-834-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH000003539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU70992Medicare UPIN
WAGAB04604Medicare ID - Type Unspecified