Provider Demographics
NPI:1558155978
Name:GERE, JUSTIN ALLEN (MSOM, LAC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ALLEN
Last Name:GERE
Suffix:
Gender:
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 501
Mailing Address - Street 2:
Mailing Address - City:WHITE SALMON
Mailing Address - State:WA
Mailing Address - Zip Code:98672-0501
Mailing Address - Country:US
Mailing Address - Phone:425-760-4059
Mailing Address - Fax:
Practice Address - Street 1:418 NE TOHOMISH ST STE 200
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672-1940
Practice Address - Country:US
Practice Address - Phone:509-213-7220
Practice Address - Fax:509-213-7221
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61542000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist