| Vital Roots Prof Corp | |
|
1225 Dexter Ave N Seattle WA 98109-3518 | |
| (206) 497-4962 | |
| (206) 316-8655 |
| Full Name | Vital Roots Prof Corp |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1225 Dexter Ave N, Seattle, Washington |
| Authorized Official Name and Position | Ryan Mackenzie Campbell (OWNER) |
| Authorized Official Contact | 6147388256 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vital Roots Prof Corp 4220 Sw 104th St Seattle WA 98146-1065 Ph: (614) 738-8256 | Vital Roots Prof Corp 1225 Dexter Ave N Seattle WA 98109-3518 Ph: (206) 497-4962 |
| NPI Number | 1366880767 |
|---|---|
| Provider Enumeration Date | 06/06/2013 |
| Last Update Date | 06/06/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366880767 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | NT60181111 (Washington) | Primary |
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