Gem Magic Healing, Inc

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

Legal business name

GEM MAGIC HEALING, INC

Doing business as

Three Moon Clinic

Practice address

19625 62ND Ave S
C-104
Kent, WA 98032-1103

Phone

(206) 838-3878

NPI assigned

Aug 28, 2012

Organization subpart

Yes

Parent organization

GEM MAGIC HEALING, INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jennifer A. McCollum, ND

Title

Medical Director

Phone

(206) 838-3879

Specialties & licenses 1

Addresses

Other names 1

• Three Moon Clinic Doing business as

Part of

Gem Magic Healing Inc

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444003200000",
    "number": "1346598034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2980 N BEVERLY GLEN CIR",
            "address_2": "SUITE 100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900771726",
            "telephone_number": "310-474-9809",
            "fax_number": "888-431-8819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19625 62ND AVE S",
            "address_2": "C-104",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980321103",
            "telephone_number": "206-838-3878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEM MAGIC HEALING, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEM MAGIC HEALING, INC",
        "enumeration_date": "2012-08-28",
        "last_updated": "2015-10-05",
        "status": "A",
        "authorized_official_last_name": "MCCOLLUM",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "206-838-3879",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ND"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Three Moon Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Non-Pharmacy Dispensing Site in Kent, WA
• Providers in Kent, WA by specialty
• Non-Pharmacy Dispensing Site in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.