Provider Demographics
NPI:1033371620
Name:PURE WELLNESS CENTERS
Entity Type:Organization
Organization Name:PURE WELLNESS CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FIELD
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:206-679-9417
Mailing Address - Street 1:3315 59TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3004
Mailing Address - Country:US
Mailing Address - Phone:206-679-9417
Mailing Address - Fax:
Practice Address - Street 1:1422 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-3813
Practice Address - Country:US
Practice Address - Phone:206-324-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT0402261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center