Provider Demographics
NPI:1992871313
Name:EDWARD H WASHINGTON JR
Entity type:Organization
Organization Name:EDWARD H WASHINGTON JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:HOLT
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:D C
Authorized Official - Phone:919-286-9430
Mailing Address - Street 1:PO BOX 2172
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27702-2172
Mailing Address - Country:US
Mailing Address - Phone:919-286-9430
Mailing Address - Fax:919-128-6362
Practice Address - Street 1:922 BROAD ST
Practice Address - Street 2:STE D
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4147
Practice Address - Country:US
Practice Address - Phone:919-286-9430
Practice Address - Fax:919-286-3624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908909Medicaid
NC8908909Medicaid
NC244373AMedicare ID - Type Unspecified