Provider Demographics
NPI:1265646244
Name:ENGSTROM, DAVID THEODORE (EAPM, LMP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:THEODORE
Last Name:ENGSTROM
Suffix:
Gender:M
Credentials:EAPM, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2372 48TH AVE SW
Mailing Address - Street 2:APT. 3
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-2345
Mailing Address - Country:US
Mailing Address - Phone:206-938-0682
Mailing Address - Fax:
Practice Address - Street 1:3618 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3702
Practice Address - Country:US
Practice Address - Phone:206-938-0682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2013-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000138171100000X
WAMA 60026945174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No174400000XOther Service ProvidersSpecialist