Provider Demographics
NPI:1689843120
Name:PARADISE RIDGE ACUPUNCTURE, HERBS & MASSAGE
Entity Type:Organization
Organization Name:PARADISE RIDGE ACUPUNCTURE, HERBS & MASSAGE
Other - Org Name:PRAHM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURIST, HERBALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LIN
Authorized Official - Last Name:BOLDING
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LAC
Authorized Official - Phone:206-463-9066
Mailing Address - Street 1:11520 SW 220TH ST
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-6448
Mailing Address - Country:US
Mailing Address - Phone:206-463-9066
Mailing Address - Fax:206-774-5929
Practice Address - Street 1:11520 SW 220TH ST
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-6448
Practice Address - Country:US
Practice Address - Phone:206-463-9066
Practice Address - Fax:206-774-5929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000717171100000X
WAAC00003080171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty