Provider Demographics
NPI:1386189983
Name:EQUILIBRIUM NATURAL HEALTH, LLC
Entity Type:Organization
Organization Name:EQUILIBRIUM NATURAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN/OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:360-698-4141
Mailing Address - Street 1:9481 BAYSHORE DR NW
Mailing Address - Street 2:STE. 103A
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8377
Mailing Address - Country:US
Mailing Address - Phone:360-698-4141
Mailing Address - Fax:877-343-5484
Practice Address - Street 1:9481 BAYSHORE DR NW
Practice Address - Street 2:STE. 103A
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8377
Practice Address - Country:US
Practice Address - Phone:360-698-4141
Practice Address - Fax:877-343-5484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT 60508818305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization