Blue Tusk Acupuncture Clinic, LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC60616546 Issued in WA

Legal business name

BLUE TUSK ACUPUNCTURE CLINIC, LLC

Practice address

5903 244TH St SW Ste E
Mountlake Terrace, WA 98043-5451

Phone

(360) 218-4602

NPI assigned

Mar 21, 2017

Last updated

Apr 17, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Andrej Prado Nickel, L.AC., EAMP

Title

Owner/ Acupuncturist

Phone

(360) 218-4602

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrej Nickel, EAMP, L.AC.

  • Acupuncturist
  • Mountlake Terrace, WA
  • NPI 1710352067
  NPD

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

{
    "created_epoch": "1490054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587081600000",
    "number": "1699206821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5903 244TH ST SW STE E",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "980435451",
            "telephone_number": "360-218-4602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5903 244TH ST SW STE E",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "980435451",
            "telephone_number": "360-218-4602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE TUSK ACUPUNCTURE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-21",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A",
        "authorized_official_last_name": "PRADO NICKEL",
        "authorized_official_first_name": "ANDREJ",
        "authorized_official_title_or_position": "OWNER/ ACUPUNCTURIST",
        "authorized_official_telephone_number": "360-218-4602",
        "authorized_official_credential": "L.AC., EAMP"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": "WA",
            "license": "AC60616546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON STATE DEPARTMENT OF HEALTH",
            "identifier": "AC60616556",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Courtney Lee Binnion, LMHCA
• Tanya Birchler, PMHNP-BC, CARN-AP
• Atila Biro, INTERPRETER
• Cristine Ann Blair, M.A.
• Anequa Blakely, LPC
• Debra Boiano
• Anastasia Bondarenko, PHARMD
• Elaine Boone Miles, MS
• David Alan Boone, CP, MPH, PHD
• Lucy L Bosche, MSW, LICSW

• Acupuncturist in Mountlake Terrace, WA
• Providers in Mountlake Terrace, WA by specialty
• Acupuncturist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2020; 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.