MEDICARE: DR. RYAN MACKENZIE CAMPBELL N.D., L.AC

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	171100000X	Acupuncturist	AC152900	OR
2	175F00000X	Naturopath	1792	OR
3	171100000X	Acupuncturist	AC60172844	WA
4	175F00000X	Naturopath	NT60181111	WA

General Provider Information

NPI Number	:	1598060758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN MACKENZIE CAMPBELL N.D., L.AC

Provider Business Mailing Address
First Line	:	4628 S AUSTIN ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-3924
Country	:	US
Telephone Number	:	614-738-8256
Fax Number	:

Provider Business Practice Location Address
First Line	:	3256 CALIFORNIA AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-3305
Country	:	US
Telephone Number	:	206-939-1393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2011
Last Update Date	:	05/21/2012

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