Healthcare Provider Details

I. General information

NPI: 1457599136
Provider Name (Legal Business Name): GJSC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15230 NE 24TH ST SUITE E (2ND FLOOR)
REDMOND WA
98052-5540
US

IV. Provider business mailing address

15230 NE 24TH ST SUITE E (2ND FLOOR)
REDMOND WA
98052-5540
US

V. Phone/Fax

Practice location:
  • Phone: 425-727-2878
  • Fax:
Mailing address:
  • Phone: 425-727-2878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034687
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNU00001972
License Number StateWA

VIII. Authorized Official

Name: DR. JEANNETTE BLAIR BIRNBACH
Title or Position: OWNER
Credential: DC MS CN CCN
Phone: 425-747-2878