MEDICARE: GOULD CHIROPRACTIC CENTER INC P S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center		WA

General Provider Information

NPI Number	:	1407035207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOULD CHIROPRACTIC CENTER INC P S

Provider Business Mailing Address
First Line	:	704 S LILLY RD
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98501-2115
Country	:	US
Telephone Number	:	360-456-4488
Fax Number	:	360-456-4577

Provider Business Practice Location Address
First Line	:	704 S LILLY RD
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98501-2115
Country	:	US
Telephone Number	:	360-456-4488
Fax Number	:	360-456-4577

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES L GOULD
Credential	:	DC
Telephone Number	:	360-456-4488

Provider Enumeration Date	:	10/29/2007
Last Update Date	:	11/16/2007

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