Provider Demographics
NPI:1326359324
Name:NORTHWEST NATUROPATHIC AND PAIN CLINIC
Entity Type:Organization
Organization Name:NORTHWEST NATUROPATHIC AND PAIN CLINIC
Other - Org Name:NW NATUROPATHIC & PAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NATUROPATHIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAVICA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:425-776-3800
Mailing Address - Street 1:21920 76TH AVE W
Mailing Address - Street 2:SUITE 203
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7980
Mailing Address - Country:US
Mailing Address - Phone:425-776-3800
Mailing Address - Fax:425-776-3844
Practice Address - Street 1:21920 76TH AVE W
Practice Address - Street 2:SUITE 203
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7980
Practice Address - Country:US
Practice Address - Phone:425-776-3800
Practice Address - Fax:425-776-3844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60024453175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty