Provider Demographics
NPI:1144351222
Name:HEALTHWISE INTEGRATIVE MEDICINE
Entity type:Organization
Organization Name:HEALTHWISE INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:ND PH D
Authorized Official - Phone:206-524-0863
Mailing Address - Street 1:4500 9TH AVE NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4737
Mailing Address - Country:US
Mailing Address - Phone:206-524-0863
Mailing Address - Fax:206-524-1019
Practice Address - Street 1:4500 9TH AVE NE
Practice Address - Street 2:SUITE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4737
Practice Address - Country:US
Practice Address - Phone:206-524-0863
Practice Address - Fax:206-524-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT1160175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty