Healthcare Provider Details

I. General information

NPI: 1942259536
Provider Name (Legal Business Name): AARON THOMAS GILLESPIE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
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 NumberCH00002513
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: