Provider Demographics
NPI:1316085822
Name:DEWEY, GORDON GEORGE (DC)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:GEORGE
Last Name:DEWEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23009 56TH AVE W
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-4713
Mailing Address - Country:US
Mailing Address - Phone:425-248-2174
Mailing Address - Fax:425-248-2175
Practice Address - Street 1:23009 56TH AVE W
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-4713
Practice Address - Country:US
Practice Address - Phone:425-248-2174
Practice Address - Fax:425-248-2175
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2052405Medicaid
WA9217000414Medicare ID - Type Unspecified
WA2052405Medicaid