Provider Demographics
NPI:1831525906
Name:REINHARD, MARK GORDON (BEE, LAC/EAMP)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:GORDON
Last Name:REINHARD
Suffix:
Gender:M
Credentials:BEE, LAC/EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 ALVORD AVE N
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-3121
Mailing Address - Country:US
Mailing Address - Phone:253-852-5506
Mailing Address - Fax:253-852-5516
Practice Address - Street 1:755 ALVORD AVE N
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-3121
Practice Address - Country:US
Practice Address - Phone:253-852-5506
Practice Address - Fax:253-852-5516
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000065171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist