Provider Demographics
NPI:1093870008
Name:EXPERIENCE ACUPUNTURE, INC
Entity Type:Organization
Organization Name:EXPERIENCE ACUPUNTURE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASTRID
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIDLER-DEVER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:206-719-5042
Mailing Address - Street 1:331 31ST AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4824
Mailing Address - Country:US
Mailing Address - Phone:206-719-5042
Mailing Address - Fax:
Practice Address - Street 1:821 E THOMAS ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-5478
Practice Address - Country:US
Practice Address - Phone:206-719-5042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC563171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty