Provider Demographics
NPI:1003482944
Name:BELLEVUE ALLERGY CLINIC
Entity Type:Organization
Organization Name:BELLEVUE ALLERGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:SPEIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-697-2122
Mailing Address - Street 1:19586 10TH AVE NE STE 300
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7332
Mailing Address - Country:US
Mailing Address - Phone:360-697-2122
Mailing Address - Fax:
Practice Address - Street 1:1260 116TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3800
Practice Address - Country:US
Practice Address - Phone:425-367-4169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1732076OtherDEA NUMBER