Provider Demographics
NPI:1346604717
Name:SOUCY-KOCHELAYEV, GABRIELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:
Last Name:SOUCY-KOCHELAYEV
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 164TH ST SE STE O
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6301
Mailing Address - Country:US
Mailing Address - Phone:425-361-6444
Mailing Address - Fax:
Practice Address - Street 1:800 164TH ST SE STE O
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-6301
Practice Address - Country:US
Practice Address - Phone:425-737-5343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60636597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor