Provider Demographics
NPI:1750520276
Name:RAICHART, DORAINE A (EAMP/ LAC, LMP)
Entity type:Individual
Prefix:
First Name:DORAINE
Middle Name:A
Last Name:RAICHART
Suffix:
Gender:F
Credentials:EAMP/ LAC, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12702 NE HOLLYHILLS DR
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-2513
Mailing Address - Country:US
Mailing Address - Phone:208-869-6209
Mailing Address - Fax:
Practice Address - Street 1:211 W HILL ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1404
Practice Address - Country:US
Practice Address - Phone:360-794-6620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60073901171100000X
WAMA00023630225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist