Healthcare Provider Details

I. General information

NPI: 1902273477
Provider Name (Legal Business Name): ALL WAYS WELL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 E CEDAR AVE STE A205
LA CENTER WA
98629-5482
US

IV. Provider business mailing address

419 E CEDAR AVE STE A05
LA CENTER WA
98629-5480
US

V. Phone/Fax

Practice location:
  • Phone: 360-952-3074
  • Fax: 360-952-3074
Mailing address:
  • Phone: 360-952-3074
  • Fax: 360-952-3074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC01021
License Number StateOR

VIII. Authorized Official

Name: MRS. REBECCA MAYRE HURWOOD KITZEROW
Title or Position: LAC
Credential: LAC
Phone: 360-952-3074