Provider Demographics
NPI:1992132765
Name:MIND & BODY NATURAL HEALING CENTER
Entity type:Organization
Organization Name:MIND & BODY NATURAL HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LI
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:360-833-2868
Mailing Address - Street 1:2115 SE 192ND AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607
Mailing Address - Country:US
Mailing Address - Phone:360-833-2868
Mailing Address - Fax:360-833-2866
Practice Address - Street 1:2115 SE 192ND AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7479
Practice Address - Country:US
Practice Address - Phone:360-833-2868
Practice Address - Fax:360-833-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000754171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty