Healthcare Provider Details

I. General information

NPI: 1255751418
Provider Name (Legal Business Name): BRANDON BENJAMIN LAC, LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2014
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 5TH AVE SE
OLYMPIA WA
98501-6918
US

IV. Provider business mailing address

106 5TH AVE SE
OLYMPIA WA
98501-6918
US

V. Phone/Fax

Practice location:
  • Phone: 360-930-9369
  • Fax:
Mailing address:
  • Phone: 360-930-9369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number70044229
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number61665597
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: