Provider Demographics
NPI:1427489392
Name:EDMONDS WELLNESS CLINIC
Entity type:Organization
Organization Name:EDMONDS WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLTING
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:425-672-2113
Mailing Address - Street 1:7935 216TH ST SW
Mailing Address - Street 2:STE E
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7941
Mailing Address - Country:US
Mailing Address - Phone:425-672-2113
Mailing Address - Fax:425-776-8873
Practice Address - Street 1:7935 216TH ST SW
Practice Address - Street 2:STE E
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7941
Practice Address - Country:US
Practice Address - Phone:425-672-2113
Practice Address - Fax:425-776-8873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60201872171100000X
WAAC00000197171100000X
WAAC00000028171100000X
WANT60186080175F00000X
WANT00001454175F00000X
WAMA00015521225700000X
WAMA00005652225700000X
WAMA00024996225700000X
WANT00000513175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty