Organization
BLUE TUSK ACUPUNCTURE CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREJ PRADO NICKEL L.AC., EAMP (OWNER/ ACUPUNCTURIST)
(360) 218-4602
Entity
Organization
Contact information
Practice address
5903 244TH ST SW STE E, MOUNTLAKE TERRACE, WA 98043-5451
(360) 218-4602
Mailing address
5903 244TH ST SW STE E, MOUNTLAKE TERRACE, WA 98043-5451
(360) 218-4602
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC60616546
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AC60616556
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
Enumeration date
03/21/2017
Last updated
04/17/2020
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