Provider Demographics
NPI:1811386212
Name:INTEGRATED CENTER FOR OPTIMUM HEALTH, LLC
Entity Type:Organization
Organization Name:INTEGRATED CENTER FOR OPTIMUM HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DE BEIJL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, PT
Authorized Official - Phone:206-623-2220
Mailing Address - Street 1:720 OLIVE WAY STE 900
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1840
Mailing Address - Country:US
Mailing Address - Phone:206-623-2220
Mailing Address - Fax:206-623-2228
Practice Address - Street 1:720 OLIVE WAY STE 900
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101
Practice Address - Country:US
Practice Address - Phone:206-623-2220
Practice Address - Fax:206-623-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002074171100000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty