Provider Demographics
NPI:1497494355
Name:EMBODIED WELLNESS LLC
Entity Type:Organization
Organization Name:EMBODIED WELLNESS LLC
Other - Org Name:NEREA ACUPUNCTURE & EASTERN MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:NEREA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEESEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, EAMP
Authorized Official - Phone:509-968-1679
Mailing Address - Street 1:6107 N ASTOR ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-8102
Mailing Address - Country:US
Mailing Address - Phone:509-968-1679
Mailing Address - Fax:509-960-9003
Practice Address - Street 1:6107 N ASTOR ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-8102
Practice Address - Country:US
Practice Address - Phone:509-968-1679
Practice Address - Fax:509-960-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAC61094788OtherWA ACUPUNCTURE LICENSE
WAAC61365635OtherWA ACUPUNCTURE LICENSE
1093352312OtherACUPUNCTURE