Provider Demographics
NPI:1669514121
Name:VERMA, VISHAL (LAC LMP)
Entity type:Individual
Prefix:
First Name:VISHAL
Middle Name:
Last Name:VERMA
Suffix:
Gender:M
Credentials:LAC LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 NW 62ND ST # A
Mailing Address - Street 2:UNIT A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-2926
Mailing Address - Country:US
Mailing Address - Phone:206-618-6230
Mailing Address - Fax:
Practice Address - Street 1:1439 NW 62ND ST # A
Practice Address - Street 2:UNIT A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-2926
Practice Address - Country:US
Practice Address - Phone:206-618-6230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002358171100000X
WAMA00018165225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist