Provider Demographics
NPI:1043736036
Name:OWENS-BAILEY, IMANI (ND, EAMP, LAC)
Entity Type:Individual
Prefix:
First Name:IMANI
Middle Name:
Last Name:OWENS-BAILEY
Suffix:
Gender:F
Credentials:ND, EAMP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 S 47TH ST APT G86
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-5548
Mailing Address - Country:US
Mailing Address - Phone:202-415-2717
Mailing Address - Fax:
Practice Address - Street 1:2211 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402
Practice Address - Country:US
Practice Address - Phone:202-415-2717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60905869175F00000X
WAAC60736407171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath