Provider Demographics
NPI:1639517220
Name:RADIANT NATUROPATHIC PLLC
Entity Type:Organization
Organization Name:RADIANT NATUROPATHIC PLLC
Other - Org Name:RADIANT NATUROPATHIC WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:425-405-4546
Mailing Address - Street 1:16455 NE 85TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3673
Mailing Address - Country:US
Mailing Address - Phone:425-405-4546
Mailing Address - Fax:425-406-6901
Practice Address - Street 1:16455 NE 85TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3673
Practice Address - Country:US
Practice Address - Phone:425-405-4546
Practice Address - Fax:425-406-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60249605261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care