Healthcare Provider Details

I. General information

NPI: 1225375702
Provider Name (Legal Business Name): MICHELE K. COLEMAN DO & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N 18TH ST SUITE B
MOUNT VERNON WA
98273-3902
US

IV. Provider business mailing address

414 E WASHINGTON ST
MOUNT VERNON WA
98274-3935
US

V. Phone/Fax

Practice location:
  • Phone: 360-630-0072
  • Fax:
Mailing address:
  • Phone: 360-630-0072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOP60188169
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP60188169
License Number StateWA

VIII. Authorized Official

Name: DR. MICHELE K COLEMAN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 360-630-0072