Provider Demographics
NPI:1821001587
Name:DICK, GORDON L (DC)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:L
Last Name:DICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:GORDON
Other - Middle Name:L
Other - Last Name:DICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:9123 ROOSEVELT WAY NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2839
Mailing Address - Country:US
Mailing Address - Phone:206-522-9500
Mailing Address - Fax:206-525-7434
Practice Address - Street 1:9123 ROOSEVELT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2839
Practice Address - Country:US
Practice Address - Phone:206-522-9500
Practice Address - Fax:206-525-7434
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0001434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA16993OtherDEPT OF LABOR AND INDUSTR
WA0001434OtherSTATE LICENSE #