Healthcare Provider Details

I. General information

NPI: 1639260615
Provider Name (Legal Business Name): INTEGRATIVE SPINE & BODY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19401 40TH AVE W SUITE 140
LYNNWOOD WA
98036-4612
US

IV. Provider business mailing address

19401 40TH AVE W SUITE 140
LYNNWOOD WA
98036-4612
US

V. Phone/Fax

Practice location:
  • Phone: 425-771-8161
  • Fax: 425-771-7929
Mailing address:
  • Phone: 425-771-8161
  • Fax: 425-771-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number602555899
License Number StateWA

VIII. Authorized Official

Name: SUSAN SCHMITT
Title or Position: OWNER
Credential: MD
Phone: 425-771-8161