Provider Demographics
NPI:1790261444
Name:FUNCTIONAL HEALTH CONSULTING, LLC
Entity Type:Organization
Organization Name:FUNCTIONAL HEALTH CONSULTING, LLC
Other - Org Name:VIDA INTEGRATED HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TROXLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-355-5222
Mailing Address - Street 1:15 SW EVERETT MALL WAY STE G
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-2715
Mailing Address - Country:US
Mailing Address - Phone:425-355-5222
Mailing Address - Fax:425-355-5231
Practice Address - Street 1:11901 NE VILLAGE PLAZA, SUITE 261
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-5092
Practice Address - Country:US
Practice Address - Phone:425-814-2800
Practice Address - Fax:425-823-0882
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FUNCTIONAL HEALTH CONSULTING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-16
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0395155OtherWA DEPT OF LNI