Healthcare Provider Details

I. General information

NPI: 1275545774
Provider Name (Legal Business Name): DIRK WILLIAM POWELL N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22421 100TH AVE SE
KENT WA
98031-4228
US

IV. Provider business mailing address

22421 100TH AVE SE
KENT WA
98031-4228
US

V. Phone/Fax

Practice location:
  • Phone: 253-852-7384
  • Fax: 253-852-7384
Mailing address:
  • Phone: 253-852-7384
  • Fax: 253-852-7384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number0000374
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: