Provider Demographics
NPI:1710408125
Name:COLVILLE NATUROPATHIC CLINIC P.S.
Entity Type:Organization
Organization Name:COLVILLE NATUROPATHIC CLINIC P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDAINE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:509-684-1104
Mailing Address - Street 1:234 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2948
Mailing Address - Country:US
Mailing Address - Phone:509-684-1104
Mailing Address - Fax:
Practice Address - Street 1:234 N OAK ST
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2948
Practice Address - Country:US
Practice Address - Phone:509-684-1104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center