Provider Demographics
NPI:1649970534
Name:GARAY, ANDRE (DC)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:GARAY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ANDRE
Other - Middle Name:
Other - Last Name:GARAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:18920 BOTHELL WAY NE STE 100
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-1981
Mailing Address - Country:US
Mailing Address - Phone:425-486-1122
Mailing Address - Fax:
Practice Address - Street 1:18920 BOTHELL WAY NE STE 100
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-1981
Practice Address - Country:US
Practice Address - Phone:425-486-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61394677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor