Healthcare Provider Details

I. General information

NPI: 1902689979
Provider Name (Legal Business Name): PHILIP VAN HUIGENBOS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 AVENUE D STE 1
SNOHOMISH WA
98290-2303
US

IV. Provider business mailing address

629 AVENUE D STE 1
SNOHOMISH WA
98290-2303
US

V. Phone/Fax

Practice location:
  • Phone: 360-568-1554
  • Fax: 360-568-1722
Mailing address:
  • Phone: 360-568-1554
  • Fax: 360-568-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberDO.OP.70105570
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number100507-851
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO.OP.70105570
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: