Provider Demographics
NPI:1801431945
Name:NATURAL LIFE MEDICINE
Entity type:Organization
Organization Name:NATURAL LIFE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAKLANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:303-519-4699
Mailing Address - Street 1:104 23RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4527
Mailing Address - Country:US
Mailing Address - Phone:253-268-2170
Mailing Address - Fax:
Practice Address - Street 1:104 23RD AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4527
Practice Address - Country:US
Practice Address - Phone:253-268-2170
Practice Address - Fax:253-268-0658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty