Provider Demographics
NPI:1407035207
Name:GOULD CHIROPRACTIC CENTER INC P S
Entity Type:Organization
Organization Name:GOULD CHIROPRACTIC CENTER INC P S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-456-4488
Mailing Address - Street 1:704 S LILLY RD
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2115
Mailing Address - Country:US
Mailing Address - Phone:360-456-4488
Mailing Address - Fax:360-456-4577
Practice Address - Street 1:704 S LILLY RD
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2115
Practice Address - Country:US
Practice Address - Phone:360-456-4488
Practice Address - Fax:360-456-4577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
T02878Medicare UPIN