Healthcare Provider Details

I. General information

NPI: 1043422983
Provider Name (Legal Business Name): ISLANDS ACUPUNCTURE, P.S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 NORTH BEACH RD.
EASTSOUND WA
98245
US

IV. Provider business mailing address

PO BOX 291
EASTSOUND WA
98245-0291
US

V. Phone/Fax

Practice location:
  • Phone: 360-376-4002
  • Fax:
Mailing address:
  • Phone: 360-376-4002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC40
License Number StateWA

VIII. Authorized Official

Name: MR. CARL I. VAN GELDER
Title or Position: OWNER
Credential: L. AC.
Phone: 360-376-4002