Healthcare Provider Details

I. General information

NPI: 1164653408
Provider Name (Legal Business Name): INTEGRATED CENTER FOR OPTIMUM HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 N 205TH ST
SHORELINE WA
98133
US

IV. Provider business mailing address

720 OLIVE WAY STE 900
SEATTLE WA
98101-1840
US

V. Phone/Fax

Practice location:
  • Phone: 206-546-2220
  • Fax: 206-546-2228
Mailing address:
  • Phone: 206-623-2220
  • Fax: 206-623-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: PAUL DE BEIJL
Title or Position: OWNER
Credential: L.AC, PT
Phone: 206-623-2220