Healthcare Provider Details

I. General information

NPI: 1598060758
Provider Name (Legal Business Name): RYAN MACKENZIE CAMPBELL N.D., L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3256 CALIFORNIA AVE SW
SEATTLE WA
98116-3305
US

IV. Provider business mailing address

4628 S AUSTIN ST
SEATTLE WA
98118-3924
US

V. Phone/Fax

Practice location:
  • Phone: 206-939-1393
  • Fax:
Mailing address:
  • Phone: 614-738-8256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC152900
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1792
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60172844
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60181111
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: