Healthcare Provider Details

I. General information

NPI: 1376793505
Provider Name (Legal Business Name): G AND M CHIRO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 N GOERIG ST SUITE H
WOODLAND WA
98674-9741
US

IV. Provider business mailing address

1227 N GOERIG ST SUITE H
WOODLAND WA
98674-9741
US

V. Phone/Fax

Practice location:
  • Phone: 360-225-1200
  • Fax: 360-225-1266
Mailing address:
  • Phone: 360-225-1200
  • Fax: 360-225-1266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034750
License Number StateWA

VIII. Authorized Official

Name: AARON THOMAS GILESPIE
Title or Position: OWNER
Credential: DC
Phone: 360-910-8910