Provider Demographics
NPI:1346660099
Name:ESSENTIAL HEALTH PLLC
Entity Type:Organization
Organization Name:ESSENTIAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLOW
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ND
Authorized Official - Phone:360-694-4811
Mailing Address - Street 1:PO BOX 560
Mailing Address - Street 2:
Mailing Address - City:LA CENTER
Mailing Address - State:WA
Mailing Address - Zip Code:98629-0560
Mailing Address - Country:US
Mailing Address - Phone:360-694-4811
Mailing Address - Fax:360-993-0423
Practice Address - Street 1:4916 NE ST JOHNS RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-2547
Practice Address - Country:US
Practice Address - Phone:360-694-4811
Practice Address - Fax:360-993-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60062846111N00000X
WANT00001012175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty