NPIMap

Organization Active NPI

Vital Roots Prof Corp

  • Primary Care Clinic/Center
  • Seattle, WA
National Provider Identifier
1366880767
Registry record updated Jun 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
NT60181111 Issued in WA
Legal business name
VITAL ROOTS PROF CORP
Practice address
1225 Dexter Ave N
Seattle, WA 98109-3518
Phone
(206) 497-4962
Fax
(206) 316-8655
NPI assigned
Jun 6, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2013

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

Authorized official

Name
Dr. Ryan Mackenzie Campbell, ND, LACNPI 1598060758
Title
Owner
Phone
(614) 738-8256

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NT60181111 WA Primary

Addresses

Primary practice location

1225 Dexter Ave N
Seattle, WA 98109-3518

Mailing address

4220 SW 104TH St
Seattle, WA 98146-1065
Phone (614) 738-8256

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1370476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370476800000",
    "number": "1366880767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4220 SW 104TH ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981461065",
            "telephone_number": "614-738-8256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 DEXTER AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981093518",
            "telephone_number": "206-497-4962",
            "fax_number": "206-316-8655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL ROOTS PROF CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-06",
        "last_updated": "2013-06-06",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "MACKENZIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "614-738-8256",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ND, LAC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WA",
            "license": "NT60181111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2013; 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.