MEDICARE: DR. JAMES L GOULD D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	911	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GO2833	OTHER	WA	BLUE SHIELD

General Provider Information

NPI Number	:	1851391106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES L GOULD D.C.

Provider Business Mailing Address
First Line	:	704 S LILLY RD
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98501-2115
Country	:	US
Telephone Number	:	360-456-4488
Fax Number	:	360-456-4577

Provider Business Practice Location Address
First Line	:	704 S LILLY RD
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98501-2115
Country	:	US
Telephone Number	:	360-456-4488
Fax Number	:	360-456-4577

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	12/07/2007

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