Provider Demographics
NPI:1093930422
Name:GIP, LUAN T (DC)
Entity Type:Individual
Prefix:
First Name:LUAN
Middle Name:T
Last Name:GIP
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 1:12221 CENTRAL VALLEY RD NW
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7011
Mailing Address - Country:US
Mailing Address - Phone:360-308-0250
Mailing Address - Fax:
Practice Address - Street 1:9414 RIDGETOP BLVD NW
Practice Address - Street 2:101
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8525
Practice Address - Country:US
Practice Address - Phone:360-308-0250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8851932Medicare PIN