Provider Demographics
NPI:1437455656
Name:FIVE RINGS
Entity Type:Organization
Organization Name:FIVE RINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-719-1744
Mailing Address - Street 1:6715 NE 63RD ST
Mailing Address - Street 2:259
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-1980
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6715 NE 63RD ST
Practice Address - Street 2:259
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-1980
Practice Address - Country:US
Practice Address - Phone:360-719-1744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty