Provider Demographics
NPI:1568800167
Name:AMOUR DE SOI WELLNESS AND SPA, PLLC
Entity Type:Organization
Organization Name:AMOUR DE SOI WELLNESS AND SPA, PLLC
Other - Org Name:AMOUR DE SOI WELLNESS AND SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:FONG
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LMP, CC, CHT
Authorized Official - Phone:206-334-1433
Mailing Address - Street 1:1836 WESTLAKE AVE N
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2755
Mailing Address - Country:US
Mailing Address - Phone:206-334-1433
Mailing Address - Fax:
Practice Address - Street 1:1836 WESTLAKE AVE N
Practice Address - Street 2:SUITE 106
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2755
Practice Address - Country:US
Practice Address - Phone:206-334-1433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60309899302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization