Provider Demographics
NPI:1376680801
Name:PISCOPO, GARY (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:PISCOPO
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 ELVA WAY
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-2104
Mailing Address - Country:US
Mailing Address - Phone:509-886-9355
Mailing Address - Fax:
Practice Address - Street 1:430 ELVA WAY
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-5418
Practice Address - Country:US
Practice Address - Phone:509-886-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0892175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath