Healthcare Provider Details

I. General information

NPI: 1780890558
Provider Name (Legal Business Name): ELYCE TAJIMA WOYCKE L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELYCE TAJIMA L.AC.

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6311 46TH AVE SW
SEATTLE WA
98136-1432
US

IV. Provider business mailing address

6311 46TH AVE SW
SEATTLE WA
98136-1432
US

V. Phone/Fax

Practice location:
  • Phone: 206-933-0909
  • Fax:
Mailing address:
  • Phone: 206-933-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number602-586-650
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: