Healthcare Provider Details

I. General information

NPI: 1619249828
Provider Name (Legal Business Name): CEIBA ACUPUNCTURE & BODYWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S 348TH ST SUITE 1
FEDERAL WAY WA
98003-7041
US

IV. Provider business mailing address

1418 S 234TH ST
DES MOINES WA
98198-7493
US

V. Phone/Fax

Practice location:
  • Phone: 206-304-2343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60065362
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA00023205
License Number StateWA

VIII. Authorized Official

Name: JAMIE DAVIS
Title or Position: ACUPUNCTURIST/OWNER
Credential: EAMP, LMP
Phone: 206-304-2343