Healthcare Provider Details

I. General information

NPI: 1740873397
Provider Name (Legal Business Name): INTEGRATIVE MEDICAL SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 02/15/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8202 NE STATE HIGHWAY 104 STE 105
KINGSTON WA
98346-9454
US

IV. Provider business mailing address

8202 NE STATE HIGHWAY 104 STE 105
KINGSTON WA
98346-9454
US

V. Phone/Fax

Practice location:
  • Phone: 360-297-0037
  • Fax: 360-297-0420
Mailing address:
  • Phone: 360-297-0037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. RAYSHEL STANTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 360-297-0037