Provider Demographics
NPI:1447674619
Name:CHADWICK, LAURA (EAMP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 STATION DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-8727
Mailing Address - Country:US
Mailing Address - Phone:312-340-1123
Mailing Address - Fax:
Practice Address - Street 1:1000 STATION DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-8727
Practice Address - Country:US
Practice Address - Phone:312-450-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-09
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60435733171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist