Provider Demographics
NPI:1790060994
Name:NORTHWEST INTEGRATIVE MEDICINE, PLLC
Entity Type:Organization
Organization Name:NORTHWEST INTEGRATIVE MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LECOVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ND, LAC
Authorized Official - Phone:425-999-4484
Mailing Address - Street 1:11520 NE 20TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3005
Mailing Address - Country:US
Mailing Address - Phone:425-999-4484
Mailing Address - Fax:425-999-4484
Practice Address - Street 1:11520 NE 20TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3005
Practice Address - Country:US
Practice Address - Phone:425-999-4484
Practice Address - Fax:425-999-4484
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST INTEGRATIVE MEDICINE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-19
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty