Healthcare Provider Details

I. General information

NPI: 1740342054
Provider Name (Legal Business Name): NORTH WEST INTEGRATIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11520 NE 20TH ST
BELLEVUE WA
98004-3005
US

IV. Provider business mailing address

11520 NE 20TH ST
BELLEVUE WA
98004-3005
US

V. Phone/Fax

Practice location:
  • Phone: 425-646-4747
  • Fax: 425-646-4770
Mailing address:
  • Phone: 425-646-4747
  • Fax: 425-646-4770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2793
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number307
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number778
License Number StateWA

VIII. Authorized Official

Name: DR. GEOFF M LECOVIN
Title or Position: OFFICER
Credential: D.C., N.D., L.AC
Phone: 425-646-4747