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General NPI Number Information
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NPI Number | 1912274408
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Entity Type | Organization
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Legal Business Name | PURITY INTEGRATIVE HEALTH & WELLNESS CENTER, PLLC
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 15118 MAIN ST SUITE 500
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City | MILL CREEK
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State | WA
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Zip | 98012-1653
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Country | US
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Telephone | 425-337-7029
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Fax |
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Provider Business Mailing Address
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Address Line | 2980 N BEVERLY GLEN CIR SUITE 100
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City | LOS ANGELES
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State | CA
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Zip | 90077-1726
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Country | US
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Telephone | 310-943-4180
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Fax | 888-431-8819
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Authorized Official
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Title or Position | OWNER
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Name | CHELSEA R. GORDON
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Credential | ND
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Telephone | 425-337-7029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | NT 60255395
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License Number State | WA
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