Healthcare Provider Details

I. General information

NPI: 1861860090
Provider Name (Legal Business Name): ROOT OF MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 LEARY AVE NW STE 202
SEATTLE WA
98107-4070
US

IV. Provider business mailing address

5401 LEARY AVE NW STE 202
SEATTLE WA
98107-4070
US

V. Phone/Fax

Practice location:
  • Phone: 206-297-6013
  • Fax: 206-582-3472
Mailing address:
  • Phone: 206-297-6013
  • Fax: 206-582-3472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60412804
License Number StateWA

VIII. Authorized Official

Name: DR. ANDREW JOHAN SIMON
Title or Position: OWNER
Credential: ND
Phone: 206-297-6013