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General NPI Number Information
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NPI Number | 1033371620
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Entity Type | Organization
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Legal Business Name | PURE WELLNESS CENTERS
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 1422 HARVARD AVE
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City | SEATTLE
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State | WA
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Zip | 98122-3813
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Country | US
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Telephone | 206-324-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 3315 59TH AVE SW
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City | SEATTLE
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State | WA
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Zip | 98116-3004
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Country | US
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Telephone | 206-679-9417
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS FIELD BALLARD
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Credential | N.D.
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Telephone | 206-679-9417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | NT0402
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License Number State | WA
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