Provider Demographics
NPI:1851643506
Name:SNOHOMISH ACUPUNCTURE & MASSAGE, LLC
Entity Type:Organization
Organization Name:SNOHOMISH ACUPUNCTURE & MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST & MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEBERLE
Authorized Official - Suffix:
Authorized Official - Credentials:EAMP, LMP
Authorized Official - Phone:360-348-2717
Mailing Address - Street 1:1400 7TH ST
Mailing Address - Street 2:STE 2
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2389
Mailing Address - Country:US
Mailing Address - Phone:360-563-5244
Mailing Address - Fax:
Practice Address - Street 1:1400 7TH ST
Practice Address - Street 2:STE 2
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2389
Practice Address - Country:US
Practice Address - Phone:360-563-5244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60208211171100000X
WAMA00014217173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty