Provider Demographics
NPI:1952592073
Name:GAMBLE, GLENN D (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:D
Last Name:GAMBLE
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 9TH AVE NE
Mailing Address - Street 2:SUITE 80
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4737
Mailing Address - Country:US
Mailing Address - Phone:206-632-2400
Mailing Address - Fax:425-454-8105
Practice Address - Street 1:1611 116TH AVE NE STE 126
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3063
Practice Address - Country:US
Practice Address - Phone:425-273-5282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002729171100000X
WANT00001284175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist