Healthcare Provider Details

I. General information

NPI: 1407074792
Provider Name (Legal Business Name): WELLNESS ONE OF BELLEVUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 NE 8TH ST SUITE 115
BELLEVUE WA
98007-4115
US

IV. Provider business mailing address

14700 NE 8TH ST SUITE 115
BELLEVUE WA
98007-4115
US

V. Phone/Fax

Practice location:
  • Phone: 425-644-8386
  • Fax: 425-644-2560
Mailing address:
  • Phone: 425-644-8386
  • Fax: 425-644-2560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00019552
License Number StateWA

VIII. Authorized Official

Name: DR. STEVEN P THAIN
Title or Position: OWNER
Credential: D.C.
Phone: 425-644-8386