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General NPI Number Information
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NPI Number | 1598011751
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Entity Type | Organization
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Legal Business Name | INTEGRATED CENTER FOR OPTIMUM HEALTH, LLC
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 701 5TH AVE STE 2160
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City | SEATTLE
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State | WA
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Zip | 98104
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Country | US
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Telephone | 206-682-3122
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Fax | 206-682-3126
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Provider Business Mailing Address
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Address Line | 720 OLIVE WAY STE 900
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City | SEATTLE
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State | WA
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Zip | 98101-1840
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Country | US
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Telephone | 206-623-2220
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Fax | 206-623-2228
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL DE BEIJL
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Credential | PT, L.AC
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Telephone | 206-623-2220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC00002074
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License Number State | WA
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