Individual
DR. GORDON A MYCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
919 STATE AVE STE 102, MARYSVILLE, WA 98270-4284
(360) 653-6010
(360) 653-6008
Mailing address
919 STATE AVE STE 102, MARYSVILLE, WA 98270-4284
(360) 653-6010
(360) 653-6008
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3460
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G8879358
MEDICARE PTAN #
WA
Enumeration date
02/22/2007
Last updated
02/15/2012
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