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Individual

DR. WILLIAM LANCE EBLEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DC

Contact information

Practice address
1233 W MAIN ST, MONROE, WA 98272-2028
(360) 794-7115
(360) 794-7114
Mailing address
PO BOX 997, MONROE, WA 98272-0997
(360) 794-7115
(360) 794-7114

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH00002018
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0026590
WORKERS COMP
WA
01
350011531
RAILROAD MEDICARE
01
CH00002018
WASH STATE
WA
01
G8904624
MEDICARE PTAN
WA
Enumeration date
08/22/2006
Last updated
06/06/2012
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