Provider Demographics
NPI:1215252291
Name:ACUPUNCTURE & HERBAL WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:ACUPUNCTURE & HERBAL WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SIK CHI
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LMT
Authorized Official - Phone:206-228-0479
Mailing Address - Street 1:33710 9TH AVE S STE 1
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6734
Mailing Address - Country:US
Mailing Address - Phone:206-228-0479
Mailing Address - Fax:888-328-1218
Practice Address - Street 1:33710 9TH AVE S STE 1
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6734
Practice Address - Country:US
Practice Address - Phone:206-228-0479
Practice Address - Fax:425-284-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00001891171100000X
WAMA00014480171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1366531758OtherNPPES - INDIVIDUAL