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General NPI Number Information
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NPI Number | 1811172059
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Entity Type | Individual
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Provider Name | GORDON RAYMOND KENT DC
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Gender | Male
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 4403 PACIFIC HIGHWAY
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City | SEAVIEW
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State | WA
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Zip | 98644-0004
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Country | US
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Telephone | 360-642-4390
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX D
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City | SEAVIEW
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State | WA
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Zip | 98644-0004
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Country | US
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Telephone | 360-642-4390
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH00001614
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License Number State | WA
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