Provider Demographics
NPI:1114242195
Name:SCHENK, MARTHA DIANE (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:DIANE
Last Name:SCHENK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21806 103RD AVENUE CT E
Mailing Address - Street 2:STE101
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-8115
Mailing Address - Country:US
Mailing Address - Phone:253-445-8181
Mailing Address - Fax:253-445-7938
Practice Address - Street 1:21806 103RD AVENUE CT E
Practice Address - Street 2:STE101
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8115
Practice Address - Country:US
Practice Address - Phone:253-445-8181
Practice Address - Fax:253-445-7938
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60145705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor