Provider Demographics
NPI:1154581015
Name:GANGADHAR INC.
Entity type:Organization
Organization Name:GANGADHAR INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:KOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-860-9090
Mailing Address - Street 1:2033 10TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4105
Mailing Address - Country:US
Mailing Address - Phone:206-860-9090
Mailing Address - Fax:206-860-3699
Practice Address - Street 1:2033 10TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-4105
Practice Address - Country:US
Practice Address - Phone:206-860-9090
Practice Address - Fax:206-860-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB35513Medicare PIN