Provider Demographics
NPI:1053481374
Name:POPHAM, SETH (LAC, LMP)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:POPHAM
Suffix:
Gender:M
Credentials:LAC, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 S COWLEY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1263
Mailing Address - Country:US
Mailing Address - Phone:509-995-7070
Mailing Address - Fax:509-838-7825
Practice Address - Street 1:922 S COWLEY ST STE 3
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1263
Practice Address - Country:US
Practice Address - Phone:509-995-7070
Practice Address - Fax:509-838-7825
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 14529225700000X
WAAC2144171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0166466OtherL&I PROVIDER #