# 5E COMMUNITY CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457779738
- **Authorized official:** MARK R TIBEAU EAMP, L.AC (SOLE MEMBER)
- **Authorized official phone:** (206) 781-1371

## Contact information

- **Practice address:** 5424 BALLARD AVE NW, SUITE 301, SEATTLE, WA 98107-4046
- **Practice address phone:** (206) 781-1371
- **Practice address fax:** (206) 781-1380
- **Mailing address:** 5424 BALLARD AVE NW, SUITE 301, SEATTLE, WA 98107-4046
- **Mailing address phone:** (206) 781-1371
- **Mailing address fax:** (206) 781-1380

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171100000X | Acupuncturist | WA-585 | WA | Yes |

## Other

- **Enumeration date:** 04/03/2014
- **Last updated:** 04/03/2014