Provider Demographics
NPI:1982758181
Name:GJERDRUM, BARRY (DC)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:GJERDRUM
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 1:7010 WOODLAWN AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5433
Mailing Address - Country:US
Mailing Address - Phone:206-517-5433
Mailing Address - Fax:206-517-5533
Practice Address - Street 1:7010 WOODLAWN AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5433
Practice Address - Country:US
Practice Address - Phone:206-517-5433
Practice Address - Fax:206-517-5533
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003329111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGJ4723OtherREGENCE RYDER NUMBER
WA128517OtherDLI NUMBER
WA128517OtherDLI NUMBER
WAGAB34373Medicare ID - Type Unspecified