Organization
VITAL ROOTS PROF CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN MACKENZIE CAMPBELL ND, LAC (OWNER)
(614) 738-8256
Entity
Organization
Contact information
Practice address
1225 DEXTER AVE N, SEATTLE, WA 98109-3518
(206) 497-4962
(206) 316-8655
Mailing address
4220 SW 104TH ST, SEATTLE, WA 98146-1065
(614) 738-8256
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
NT60181111
WA
Other
Enumeration date
06/06/2013
Last updated
06/06/2013
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