Provider Demographics
NPI:1093137432
Name:118CLINIC INC.
Entity Type:Organization
Organization Name:118CLINIC INC.
Other - Org Name:3RD SPACE COMMUNITY ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:IGNACIO
Authorized Official - Last Name:PALACIOS
Authorized Official - Suffix:
Authorized Official - Credentials:EAMP
Authorized Official - Phone:206-458-8552
Mailing Address - Street 1:4516 EVANSTON AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6431
Mailing Address - Country:US
Mailing Address - Phone:206-453-8552
Mailing Address - Fax:
Practice Address - Street 1:3811 S FERDINAND ST
Practice Address - Street 2:APT B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1759
Practice Address - Country:US
Practice Address - Phone:206-760-6064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-18
Last Update Date:2014-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty