Provider Demographics
NPI:1326223900
Name:MARISA E DELISLE, DC PS
Entity Type:Organization
Organization Name:MARISA E DELISLE, DC PS
Other - Org Name:NORTHWEST FAMILY CHIROPRACTIC AND MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DE LISLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-363-4478
Mailing Address - Street 1:14709 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6547
Mailing Address - Country:US
Mailing Address - Phone:206-363-4478
Mailing Address - Fax:
Practice Address - Street 1:14709 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-6547
Practice Address - Country:US
Practice Address - Phone:206-363-4478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8859720Medicare PIN