Provider Demographics
NPI:1487923835
Name:GORDON, CHELSEA RAE HOLZINGER (ND)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:RAE HOLZINGER
Last Name:GORDON
Suffix:
Gender:F
Credentials:ND
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 14577
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98082-2577
Mailing Address - Country:US
Mailing Address - Phone:425-286-8803
Mailing Address - Fax:866-394-3445
Practice Address - Street 1:10315 19TH AVE SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4268
Practice Address - Country:US
Practice Address - Phone:425-286-8803
Practice Address - Fax:866-394-3445
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60255395175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath