Provider Demographics
NPI:1356189518
Name:GARENT, NATHANAEL MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:MICHAEL
Last Name:GARENT
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 1:9 E 1ST AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-1400
Mailing Address - Country:US
Mailing Address - Phone:509-697-4838
Mailing Address - Fax:509-697-6132
Practice Address - Street 1:9 E 1ST AVE STE 1
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-1400
Practice Address - Country:US
Practice Address - Phone:509-697-4838
Practice Address - Fax:509-697-6132
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61577017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty