Healthcare Provider Details

I. General information

NPI: 1699183723
Provider Name (Legal Business Name): MARTIN ACUPUNCTURE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 LEARY AVE NW
SEATTLE WA
98107-4070
US

IV. Provider business mailing address

5401 LEARY AVE NW
SEATTLE WA
98107-4070
US

V. Phone/Fax

Practice location:
  • Phone: 206-582-3469
  • Fax: 206-582-3472
Mailing address:
  • Phone: 206-582-3469
  • Fax: 206-582-3472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00002958
License Number StateWA

VIII. Authorized Official

Name: MR. TYLER MARTIN
Title or Position: OWNER
Credential: L.AC. EAMP
Phone: 206-582-3469