Provider Demographics
NPI:1831268853
Name:GOBER, KENNETH W (DC)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:W
Last Name:GOBER
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 1:12826 SE 40TH LN
Mailing Address - Street 2:STE. 105
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-4278
Mailing Address - Country:US
Mailing Address - Phone:425-746-0420
Mailing Address - Fax:425-746-1587
Practice Address - Street 1:12826 SE 40TH LN
Practice Address - Street 2:STE. 105
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-4278
Practice Address - Country:US
Practice Address - Phone:425-746-0420
Practice Address - Fax:425-746-1587
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2006054Medicaid
WA93335OtherLABOR & INDUSTRIES
91-1348654OtherFEDERAL TAX ID NUMBER
G000106121Medicare PIN
T60930Medicare UPIN
WAT60930Medicare UPIN
WA000106121Medicare ID - Type Unspecified