MEDICARE: ESSENTIAL WELLNESS INTEGRATIVE MEDICINE AND ACUPUNCTURE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site	NT60418970	WA

General Provider Information

NPI Number	:	1316306319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENTIAL WELLNESS INTEGRATIVE MEDICINE AND ACUPUNCTURE, PLLC

Provider Business Mailing Address
First Line	:	2980 N BEVERLY GLEN CIR
Second Line	:	SUITE 100
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-1726
Country	:	US
Telephone Number	:	310-943-4180
Fax Number	:	888-431-8819

Provider Business Practice Location Address
First Line	:	3204 SMOKEY POINT DR
Second Line	:	SUITE 102
City	:	ARLINGTON
State	:	WA
Zip	:	98223-8476
Country	:	US
Telephone Number	:	360-436-6303
Fax Number	:	888-431-8819

Authorized Official
Title or Position	:	OWNER
Name	:	ERICA M. SPIELMANN-SCHULTZ
Credential	:	N.D.
Telephone Number	:	360-436-6303

Provider Enumeration Date	:	02/18/2016
Last Update Date	:	02/18/2016

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