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Individual

DR. MYSTIQUE D GROBE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ND,LAC

Contact information

Practice address
851 COHO WAY, #309, BELLINGHAM, WA 98225-2067
(360) 527-2812
(360) 734-3088
Mailing address
851 COHO WAY, #309, BELLINGHAM, WA 98225-2067
(360) 527-2812
(360) 734-3088

Taxonomy

Speciality
Code
Description
License number
State
171100000X
Acupuncturist
AC00000225
WA
175F00000X
Naturopath
Primary
NT00000713
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
912061822
FED TAX ID
01
AC00000225
STATE LICENSE
WA
01
NT00000713
STATE LICENSE
WA
Enumeration date
01/09/2007
Last updated
09/13/2013
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