Healthcare Provider Details

I. General information

NPI: 1790261444
Provider Name (Legal Business Name): FUNCTIONAL HEALTH CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11901 NE VILLAGE PLAZA, SUITE 261
KIRKLAND WA
98034-5092
US

IV. Provider business mailing address

15 SW EVERETT MALL WAY STE G
EVERETT WA
98204-2715
US

V. Phone/Fax

Practice location:
  • Phone: 425-814-2800
  • Fax: 425-823-0882
Mailing address:
  • Phone: 425-355-5222
  • Fax: 425-355-5231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE TROXLER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 425-355-5222