Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | NT61195829 | WA |
N | 225700000X | Massage Therapist | MA60792173 | WA |
NPI | 1104496132 |
---|---|
Provider Name | Dr. Andrew Dzikowski |
First Address | Lynnwood, WA 98036-7650 |
Second Address | Lynnwood, WA 98036-7650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2021 |
Last Update Date | 26/10/2021 |