Healthcare Provider Details

I. General information

NPI: 1962587824
Provider Name (Legal Business Name): ACUPUNCTURE CLINIC NORTH WEST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16761 NE 79TH ST
REDMOND WA
98052-4425
US

IV. Provider business mailing address

16761 NE 79TH ST
REDMOND WA
98052-4425
US

V. Phone/Fax

Practice location:
  • Phone: 425-869-7400
  • Fax: 425-869-5400
Mailing address:
  • Phone: 425-869-7400
  • Fax: 425-869-5400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: TODD STEPHEN HYMEL
Title or Position: OWNER
Credential: M.S.A.; LAC
Phone: 206-683-8202