Provider Demographics
NPI:1518599273
Name:ETHERTON, INC
Entity Type:Organization
Organization Name:ETHERTON, INC
Other - Org Name:OLYMPIA INTEGRATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ETHERTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:360-915-9389
Mailing Address - Street 1:2610 YELM HWY SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4826
Mailing Address - Country:US
Mailing Address - Phone:360-915-9389
Mailing Address - Fax:360-925-3136
Practice Address - Street 1:2610 YELM HWY SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-4826
Practice Address - Country:US
Practice Address - Phone:360-870-2011
Practice Address - Fax:360-925-3136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty