Provider Demographics
NPI:1114227816
Name:LAKE CITY NATUROPATHIC CARE
Entity Type:Organization
Organization Name:LAKE CITY NATUROPATHIC CARE
Other - Org Name:STEVENS NATUROPATHIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:509-590-1343
Mailing Address - Street 1:21950 E COUNTRY VISTA DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-6005
Mailing Address - Country:US
Mailing Address - Phone:509-590-1343
Mailing Address - Fax:866-774-8216
Practice Address - Street 1:21950 E COUNTRY VISTA DR
Practice Address - Street 2:SUITE 600
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-6005
Practice Address - Country:US
Practice Address - Phone:509-590-1343
Practice Address - Fax:866-774-8216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001415175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty