Provider Demographics
NPI: | 1750403168 |
---|---|
Name: | NEARY NATUROPATHIC CLINIC, LLC |
Entity type: | Organization |
Organization Name: | NEARY NATUROPATHIC CLINIC, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DEAN |
Authorized Official - Middle Name: | E |
Authorized Official - Last Name: | NEARY |
Authorized Official - Suffix: | JR |
Authorized Official - Credentials: | ND |
Authorized Official - Phone: | 206-817-9765 |
Mailing Address - Street 1: | PO BOX 3382 |
Mailing Address - Street 2: | |
Mailing Address - City: | EVERETT |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98213-8382 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 206-817-9765 |
Mailing Address - Fax: | 360-652-4472 |
Practice Address - Street 1: | 2615 W CASINO RD STE 1B |
Practice Address - Street 2: | |
Practice Address - City: | EVERETT |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98204-2109 |
Practice Address - Country: | US |
Practice Address - Phone: | 206-817-9765 |
Practice Address - Fax: | 360-652-4472 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-04-04 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | NT00000783 | 175F00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 175F00000X | Other Service Providers | Naturopath | Group - Single Specialty |