Provider Demographics
NPI:1396411625
Name:REARDON, GABRIEL ALBAN (DC)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:ALBAN
Last Name:REARDON
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 1:1717 NE 44TH ST STE G
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-9001
Mailing Address - Country:US
Mailing Address - Phone:425-277-4098
Mailing Address - Fax:425-277-8239
Practice Address - Street 1:1717 NE 44TH ST STE G
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-9001
Practice Address - Country:US
Practice Address - Phone:425-277-4098
Practice Address - Fax:425-277-8239
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACHIR.CH.61194549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor