Healthcare Provider Details

I. General information

NPI: 1831268853
Provider Name (Legal Business Name): KENNETH W. GOBER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12826 SE 40TH LN STE. 105
BELLEVUE WA
98006-4278
US

IV. Provider business mailing address

12826 SE 40TH LN STE. 105
BELLEVUE WA
98006-4278
US

V. Phone/Fax

Practice location:
  • Phone: 425-746-0420
  • Fax: 425-746-1587
Mailing address:
  • Phone: 425-746-0420
  • Fax: 425-746-1587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2050
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: