Provider Demographics
NPI:1629450739
Name:HEALTHY BALANCE NATURAL MEDICINE PLLC
Entity Type:Organization
Organization Name:HEALTHY BALANCE NATURAL MEDICINE PLLC
Other - Org Name:SOUND HOLISTIC HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:ND,
Authorized Official - Phone:425-258-4633
Mailing Address - Street 1:2804 GRAND AVE
Mailing Address - Street 2:STE. 300
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3430
Mailing Address - Country:US
Mailing Address - Phone:425-258-4633
Mailing Address - Fax:425-258-4644
Practice Address - Street 1:2804 GRAND AVE
Practice Address - Street 2:STE. 300
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3430
Practice Address - Country:US
Practice Address - Phone:425-258-4633
Practice Address - Fax:425-258-4644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60509959133V00000X
WAAC00002968171100000X
WAAC60307412171100000X
WANT00001544175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty