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General NPI Number Information
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NPI Number | 1215092093
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Entity Type | Organization
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Legal Business Name | MARKET STREET INTEGRATIVE HEALTH
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 607 MARKET STREET SUITE A
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City | KIRKLAND
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State | WA
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Zip | 98033
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Country | US
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Telephone | 425-822-8356
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Fax | 425-822-7842
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Provider Business Mailing Address
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Address Line | 607 MARKET STREET SUITE A
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City | KIRKLAND
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State | WA
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Zip | 98033
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Country | US
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Telephone | 425-822-8356
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Fax | 425-822-7842
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Authorized Official
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Title or Position | NATUROPATH & ACUPUNCTURIST
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Name | DR. SCOTT D ROSE
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Credential | ND, LAC
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Telephone | 425-576-8017
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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 | AC2255
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | NT1154
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License Number State | WA
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