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General NPI Number Information
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NPI Number | 1093870008
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Entity Type | Organization
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Legal Business Name | EXPERIENCE ACUPUNTURE, INC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 821 E THOMAS ST
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City | SEATTLE
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State | WA
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Zip | 98102-5478
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Country | US
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Telephone | 206-719-5042
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Fax |
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Provider Business Mailing Address
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Address Line | 331 31ST AVE E
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City | SEATTLE
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State | WA
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Zip | 98112-4824
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Country | US
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Telephone | 206-719-5042
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ASTRID E SIDLER-DEVER
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Credential | L.AC
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Telephone | 206-719-5042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC563
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License Number State | WA
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