MEDICARE: COLVILLE NATUROPATHIC CLINIC P.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1710408125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLVILLE NATUROPATHIC CLINIC P.S.

Provider Business Mailing Address
First Line	:	234 N OAK ST
Second Line	:
City	:	COLVILLE
State	:	WA
Zip	:	99114-2948
Country	:	US
Telephone Number	:	509-684-1104
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 N OAK ST
Second Line	:
City	:	COLVILLE
State	:	WA
Zip	:	99114-2948
Country	:	US
Telephone Number	:	509-684-1104
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RANDY SANDAINE
Credential	:	ND
Telephone Number	:	509-684-1104

Provider Enumeration Date	:	07/06/2017
Last Update Date	:	07/21/2022

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1891792966 — STEVENS COUNTY
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Directions to “COLVILLE NATUROPATHIC CLINIC P.S. ” Practice Location

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