Provider Demographics
NPI:1275545774
Name:POWELL, DIRK WILLIAM (ND)
Entity Type:Individual
Prefix:DR
First Name:DIRK
Middle Name:WILLIAM
Last Name:POWELL
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22421 100TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-4228
Mailing Address - Country:US
Mailing Address - Phone:253-852-7384
Mailing Address - Fax:253-852-7384
Practice Address - Street 1:22421 100TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-4228
Practice Address - Country:US
Practice Address - Phone:253-852-7384
Practice Address - Fax:253-852-7384
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0000374175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0000374OtherWA STATE LICENSE - ND
WA0157196OtherL&I PROVIDER #