Provider Demographics
NPI:1851391106
Name:GOULD, JAMES L (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:GOULD
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 1:704 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
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGO2833OtherBLUE SHIELD
WAT02878Medicare UPIN
WA8869055Medicare PIN