Provider Demographics
NPI:1710352067
Name:NICKEL, ANDREJ (EAMP, LAC)
Entity Type:Individual
Prefix:MR
First Name:ANDREJ
Middle Name:
Last Name:NICKEL
Suffix:
Gender:M
Credentials:EAMP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5903 244TH ST SW STE E
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-5451
Mailing Address - Country:US
Mailing Address - Phone:306-218-4602
Mailing Address - Fax:
Practice Address - Street 1:5903 244TH ST SW STE E
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-5451
Practice Address - Country:US
Practice Address - Phone:306-218-4602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60656146171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAC60616546OtherSTATE LICENSE