Provider Demographics
NPI:1093316614
Name:EASTSIDE INTEGRATIVE MEDICINE, PLLC
Entity Type:Organization
Organization Name:EASTSIDE INTEGRATIVE MEDICINE, PLLC
Other - Org Name:EASTSIDE INTEGRATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:360-200-4082
Mailing Address - Street 1:23111 105TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-7809
Mailing Address - Country:US
Mailing Address - Phone:360-200-4082
Mailing Address - Fax:866-248-9597
Practice Address - Street 1:23111 105TH ST SE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-7809
Practice Address - Country:US
Practice Address - Phone:425-327-3889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty