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General NPI Number Information
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NPI Number | 1417864778
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Entity Type | Organization
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Legal Business Name | HEALTHY ROOTS CLINIC LLC
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Dates
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Enumeration Date | 08/24/2026
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Last Update Date | 08/24/2026
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Provider Practice Location Address
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Address Line | 21101 NE CEDAR CREEK RD
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City | AMBOY
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State | WA
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Zip | 98601-3802
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Country | US
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Telephone | 303-815-7346
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 340
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City | BATTLE GROUND
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State | WA
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Zip | 98604-0340
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANAHEED JACKSON
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Credential | ND
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Telephone | 303-815-7346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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