Provider Demographics
NPI:1669833398
Name:EMERALD CITY COOPERATIVE CARE
Entity Type:Organization
Organization Name:EMERALD CITY COOPERATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICE AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEDERMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:206-781-2206
Mailing Address - Street 1:1409 NW 85TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-4237
Mailing Address - Country:US
Mailing Address - Phone:206-781-2206
Mailing Address - Fax:206-783-3949
Practice Address - Street 1:1409 NW 85TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-4237
Practice Address - Country:US
Practice Address - Phone:206-781-2206
Practice Address - Fax:206-783-3949
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMERALD CITY NATUROPATHIC CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60427838171100000X
WANT60422120175F00000X
WANT681175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1295863397OtherNPI
WA1205266533OtherNPI