Provider Demographics
NPI:1679609176
Name:NATURAL WELLNESS CENTER, PS
Entity Type:Organization
Organization Name:NATURAL WELLNESS CENTER, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:KINNEAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-839-8608
Mailing Address - Street 1:30821 PACIFIC HWY S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4901
Mailing Address - Country:US
Mailing Address - Phone:253-839-8608
Mailing Address - Fax:253-941-6821
Practice Address - Street 1:30821 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4901
Practice Address - Country:US
Practice Address - Phone:253-839-8608
Practice Address - Fax:253-941-6821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001877111N00000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA88915OtherLABOR & INDUSTRIES
WAG8865046Medicare UPIN