Provider Demographics
NPI:1801015912
Name:BASTYR UNIVERSITY
Entity Type:Organization
Organization Name:BASTYR UNIVERSITY
Other - Org Name:BASTYR CENTER FOR NATURAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:206-834-4100
Mailing Address - Street 1:3670 STONE WAY N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8004
Mailing Address - Country:US
Mailing Address - Phone:206-834-4100
Mailing Address - Fax:
Practice Address - Street 1:3670 STONE WAY N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8004
Practice Address - Country:US
Practice Address - Phone:206-834-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Not Answered175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty