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General NPI Number Information
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NPI Number | 1073715306
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Entity Type | Organization
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Legal Business Name | DR BARRY GJERDRUM PS
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 7010 WOODLAWN AVE NE
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City | SEATTLE
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State | WA
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Zip | 98115-5433
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Country | US
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Telephone | 206-517-5433
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Fax | 206-517-5533
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Provider Business Mailing Address
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Address Line | 7010 WOODLAWN AVE NE
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City | SEATTLE
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State | WA
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Zip | 98115-5433
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Country | US
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Telephone | 206-517-5433
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Fax | 206-517-5533
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Authorized Official
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Title or Position | OWNER
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Name | BARRY GJERDRUM
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Credential | DC
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Telephone | 206-517-5433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00022012
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH00003329
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License Number State | WA
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