Basic Information
| Provider Information | |||||||||
| NPI: | 1033679303 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOODINVILLE NATURAL HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15610 NE WOODINVILLE DUVALL RD STE 108 | ||||||||
| Address2: | |||||||||
| City: | WOODINVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980727069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254895900 | ||||||||
| FaxNumber: | 4254895920 | ||||||||
| Practice Location | |||||||||
| Address1: | 15610 NE WOODINVILLE DUVALL RD STE 108 | ||||||||
| Address2: | |||||||||
| City: | WOODINVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980727069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254895900 | ||||||||
| FaxNumber: | 4254895920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2019 | ||||||||
| LastUpdateDate: | 03/22/2019 | ||||||||
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| AuthorizedOfficialLastName: | SULLIVAN | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER OF LLC | ||||||||
| AuthorizedOfficialTelephone: | 2065698637 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | ND | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 171100000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Acupuncturist | 225700000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 175F00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Naturopath |
No ID Information.