Provider Demographics
NPI:1184995490
Name:MICHAEL PREVEC LLC
Entity type:Organization
Organization Name:MICHAEL PREVEC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/MASSAGE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PREVEC
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LMP
Authorized Official - Phone:360-694-7668
Mailing Address - Street 1:1906 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3325
Mailing Address - Country:US
Mailing Address - Phone:360-694-7668
Mailing Address - Fax:360-694-9531
Practice Address - Street 1:1906 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3325
Practice Address - Country:US
Practice Address - Phone:360-694-7668
Practice Address - Fax:360-694-9531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60251662171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty