Provider Demographics
NPI:1457599136
Name:GJSC, LLC
Entity Type:Organization
Organization Name:GJSC, LLC
Other - Org Name:DESIGNED CLINICAL NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:BIRNBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC MS CN CCN
Authorized Official - Phone:425-747-2878
Mailing Address - Street 1:15230 NE 24TH ST
Mailing Address - Street 2:SUITE E (2ND FLOOR)
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5540
Mailing Address - Country:US
Mailing Address - Phone:425-727-2878
Mailing Address - Fax:
Practice Address - Street 1:15230 NE 24TH ST
Practice Address - Street 2:SUITE E (2ND FLOOR)
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5540
Practice Address - Country:US
Practice Address - Phone:425-727-2878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034687111N00000X
WANU00001972133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty