Organization · NPI-2

5e Community Clinic, LLC

Acupuncturist · Seattle, WA

NPI number1457779738
StatusActive
Last updated in NPPESApr 3, 2014

Details

NPI
1457779738
Entity type
Organization (NPI-2)
Legal business name
5e Community Clinic, LLC
Organization subpart
No
Enumeration date
Apr 3, 2014
Last updated
Apr 3, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
171100000X AcupuncturistWA-585WAYes

Practice location

5424 Ballard Ave Nw
Suite 301
Seattle, WA 98107-4046

Phone 206-781-1371 · Fax 206-781-1380

Mailing address

5424 Ballard Ave Nw
Suite 301
Seattle, WA 98107-4046

Phone 206-781-1371 · Fax 206-781-1380

Authorized official

Mark R Tibeau
Sole Member
2067811371

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