MEDICARE: ABSOLUTE WELLNESS CLINIC, P.S.

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	NT60060007	WA

General Provider Information

NPI Number	:	1841646296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABSOLUTE WELLNESS CLINIC, P.S.

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	:	465 RAINIER BLVD N
Second Line	:	SUITE A
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-2826
Country	:	US
Telephone Number	:	425-392-5321
Fax Number	:	888-431-8819

Authorized Official
Title or Position	:	OWNER
Name	:	LINDSAY A. WAIS
Credential	:	ND
Telephone Number	:	425-392-5321

Provider Enumeration Date	:	05/04/2016
Last Update Date	:	05/04/2016

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