Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | MA 60582644 | WA |
NPI | 1104281153 |
---|---|
Provider Name | Miss Rielle Hara Gordon |
First Address | Seattle, WA 98121 |
Second Address | Seattle, WA 98101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2015 |
Last Update Date | 17/12/2015 |