Provider Demographics
NPI:1205932019
Name:GILBERTSON, DAVID LAWRENCE (,DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:GILBERTSON
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 1:16212 BOTHELL EVERETT HWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1603
Mailing Address - Country:US
Mailing Address - Phone:425-745-4430
Mailing Address - Fax:425-745-3572
Practice Address - Street 1:16212 BOTHELL EVERETT HWY
Practice Address - Street 2:SUITE E
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1603
Practice Address - Country:US
Practice Address - Phone:425-745-4430
Practice Address - Fax:425-745-3572
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA25059OtherWA DEPARTMENT OF L&I
WAR70357OtherREGENCE PROVIDER #
WAT02989Medicare UPIN