Provider Demographics
NPI:1326458910
Name:INSTITUTE OF COMPLEMENTARY MEDICINE LLC
Entity Type:Organization
Organization Name:INSTITUTE OF COMPLEMENTARY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:CELMER
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:206-726-0034
Mailing Address - Street 1:1600 E JEFFERSON STREET
Mailing Address - Street 2:SUITE 603
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122
Mailing Address - Country:US
Mailing Address - Phone:206-726-0034
Mailing Address - Fax:206-726-9434
Practice Address - Street 1:1600 E JEFFERSON STREET
Practice Address - Street 2:SUITE 603
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122
Practice Address - Country:US
Practice Address - Phone:206-726-0034
Practice Address - Fax:206-726-9434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA00000832175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty