Provider Demographics
NPI:1639813330
Name:ELEVATED ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:ELEVATED ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MSAOM, RN
Authorized Official - Phone:303-378-0557
Mailing Address - Street 1:9810 42ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-2819
Mailing Address - Country:US
Mailing Address - Phone:303-378-0557
Mailing Address - Fax:
Practice Address - Street 1:1500 FAIRVIEW AVE E STE 205
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3727
Practice Address - Country:US
Practice Address - Phone:253-987-6049
Practice Address - Fax:206-325-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0002552OtherCO STATE ACUPUNCTURE LICENSE
WAAC61079087OtherWA STATE ACUPUNCTURE LICENSE
NCC84637OtherNCCAOM BOARD CERTIFICATION
1588202782OtherINDIVIDUAL NPI