Organization
5E COMMUNITY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK R TIBEAU EAMP, L.AC (SOLE MEMBER)
(206) 781-1371
Entity
Organization
Contact information
Practice address
5424 BALLARD AVE NW, SUITE 301, SEATTLE, WA 98107-4046
(206) 781-1371
(206) 781-1380
Mailing address
5424 BALLARD AVE NW, SUITE 301, SEATTLE, WA 98107-4046
(206) 781-1371
(206) 781-1380
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
WA-585
WA
Other
Enumeration date
04/03/2014
Last updated
04/03/2014
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