Provider Demographics
NPI:1528416203
Name:JASON W GOOCH INC
Entity Type:Organization
Organization Name:JASON W GOOCH INC
Other - Org Name:SOUND PHYSICAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:W
Authorized Official - Last Name:GOOCH
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LMP
Authorized Official - Phone:206-629-4343
Mailing Address - Street 1:18528 FIRLANDS WAY N
Mailing Address - Street 2:SUITE D
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3985
Mailing Address - Country:US
Mailing Address - Phone:206-629-4343
Mailing Address - Fax:206-801-7365
Practice Address - Street 1:18528 FIRLANDS WAY N
Practice Address - Street 2:SUITE D
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3985
Practice Address - Country:US
Practice Address - Phone:206-629-4343
Practice Address - Fax:206-801-7365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60198440175F00000X
WANT60633670175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty