Provider Demographics
NPI:1366905101
Name:NEWELL, JUSTIN RAY (ND)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:RAY
Last Name:NEWELL
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 116TH AVE NE STE C
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3802
Mailing Address - Country:US
Mailing Address - Phone:425-451-0404
Mailing Address - Fax:
Practice Address - Street 1:1200 116TH AVE NE STE C
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3802
Practice Address - Country:US
Practice Address - Phone:425-451-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60904693175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANT60904693OtherMEDICAL LICENSE