Provider Demographics
NPI:1073060729
Name:COMMUNITY HEALTH ACUPUNCTURE AND WELLNESS CENTER
Entity Type:Organization
Organization Name:COMMUNITY HEALTH ACUPUNCTURE AND WELLNESS CENTER
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:NIMULRITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SETH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:425-586-0459
Mailing Address - Street 1:15102 61ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-4208
Mailing Address - Country:US
Mailing Address - Phone:425-586-0459
Mailing Address - Fax:
Practice Address - Street 1:5108 196TH ST SW STE 208
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6152
Practice Address - Country:US
Practice Address - Phone:425-586-0459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60271621305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization