Provider Demographics
NPI:1265779730
Name:ACCUPUNTURE CLINIC OF EDMONDS
Entity type:Organization
Organization Name:ACCUPUNTURE CLINIC OF EDMONDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-771-0184
Mailing Address - Street 1:8000 212TH ST SW STE E
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7451
Mailing Address - Country:US
Mailing Address - Phone:425-776-6930
Mailing Address - Fax:
Practice Address - Street 1:8000 212TH ST SW STE E
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7451
Practice Address - Country:US
Practice Address - Phone:425-776-6930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000175171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty