Healthcare Provider Details

I. General information

NPI: 1326316928
Provider Name (Legal Business Name): HEALING PONDS NORTHWEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 CALIFORNIA AVE SW
SEATTLE WA
98116-2403
US

IV. Provider business mailing address

2324 CALIFORNIA AVE SW
SEATTLE WA
98116-2403
US

V. Phone/Fax

Practice location:
  • Phone: 206-682-0676
  • Fax: 206-623-0397
Mailing address:
  • Phone: 206-682-0676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH60076566
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60091482
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALICIA XENIA POND
Title or Position: OWNER
Credential: EAMP
Phone: 206-795-6462