Healthcare Provider Details

I. General information

NPI: 1366673550
Provider Name (Legal Business Name): JADE SPRING WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8529 124TH AVE NE
KIRKLAND WA
98033-5857
US

IV. Provider business mailing address

8529 124TH AVE NE
KIRKLAND WA
98033-5857
US

V. Phone/Fax

Practice location:
  • Phone: 425-803-2050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateWA

VIII. Authorized Official

Name: JEWELL SMITH
Title or Position: ACUPUNCTURIST
Credential: M.S. LAC
Phone: 425-803-2050