Provider Demographics
NPI:1568703908
Name:NICKELS NATURAL HEALTH LLC
Entity Type:Organization
Organization Name:NICKELS NATURAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NATUROPATHIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKELS
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:360-818-4218
Mailing Address - Street 1:301 E MCLOUGHLIN BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3366
Mailing Address - Country:US
Mailing Address - Phone:360-818-4218
Mailing Address - Fax:360-859-4536
Practice Address - Street 1:301 E MCLOUGHLIN BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3366
Practice Address - Country:US
Practice Address - Phone:360-818-4218
Practice Address - Fax:360-859-4536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60054014171100000X
ORAC01291171100000X
WANT60051160175F00000X
OR1669175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty