Healthcare Provider Details

I. General information

NPI: 1669833398
Provider Name (Legal Business Name): EMERALD CITY COOPERATIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 NW 85TH ST
SEATTLE WA
98117-4237
US

IV. Provider business mailing address

1409 NW 85TH ST
SEATTLE WA
98117-4237
US

V. Phone/Fax

Practice location:
  • Phone: 206-781-2206
  • Fax: 206-783-3949
Mailing address:
  • Phone: 206-781-2206
  • Fax: 206-783-3949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60427838
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60422120
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT681
License Number StateWA

VIII. Authorized Official

Name: MOLLY NIEDERMEYER
Title or Position: CHIEF MEDICAL OFFICE AND OWNER
Credential: N.D.
Phone: 206-781-2206