Provider Demographics
NPI:1396295408
Name:CHANG, GRACE JAMIE (ND, EAMP/LAC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:JAMIE
Last Name:CHANG
Suffix:
Gender:F
Credentials:ND, EAMP/LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 NE 45TH ST
Mailing Address - Street 2:2 WEST
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5660
Mailing Address - Country:US
Mailing Address - Phone:206-535-7527
Mailing Address - Fax:
Practice Address - Street 1:3513 NE 45TH ST
Practice Address - Street 2:2 WEST
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5660
Practice Address - Country:US
Practice Address - Phone:206-535-7527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60692417171100000X
WANT60683686175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist