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General NPI Number Information
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NPI Number | 1467721852
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Entity Type | Organization
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Legal Business Name | FLOURISH LLC
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Dates
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Enumeration Date | 12/14/2011
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Last Update Date | 12/14/2011
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Provider Practice Location Address
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Address Line | 8301 NE HAZEL DELL AVE
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City | VANCOUVER
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State | WA
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Zip | 98665-8047
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Country | US
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Telephone | 360-696-3800
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Fax | 360-696-0906
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Provider Business Mailing Address
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Address Line | PO BOX 65759
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City | VANCOUVER
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State | WA
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Zip | 98665-0026
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Country | US
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Telephone | 360-696-3800
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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. JAYMIE MACKLER
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Credential | N.D., LAC
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Telephone | 360-696-3800
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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 | AC 00002759
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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 | NT00001411
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License Number State | WA
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