Provider Demographics
NPI:1295168946
Name:KEYSTONE NATURAL MEDICINE, LLC
Entity type:Organization
Organization Name:KEYSTONE NATURAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIKA
Authorized Official - Middle Name:CHERYL YUKO
Authorized Official - Last Name:ODAMA
Authorized Official - Suffix:
Authorized Official - Credentials:ND, EAMP
Authorized Official - Phone:425-822-4325
Mailing Address - Street 1:5422 212TH ST SW
Mailing Address - Street 2:#G203
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2088
Mailing Address - Country:US
Mailing Address - Phone:206-321-6913
Mailing Address - Fax:425-284-2499
Practice Address - Street 1:30 LAKE SHORE PLZ
Practice Address - Street 2:SUITE B
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6175
Practice Address - Country:US
Practice Address - Phone:425-822-4325
Practice Address - Fax:425-284-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60201872171100000X
WANT.60186080175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty