Provider Demographics
NPI:1376564252
Name:ILYANKOFF, LISA M (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:ILYANKOFF
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 1:2003 132ND ST SE
Mailing Address - Street 2:SUITE E
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7140
Mailing Address - Country:US
Mailing Address - Phone:425-379-6301
Mailing Address - Fax:425-379-5761
Practice Address - Street 1:2003 132ND ST SE
Practice Address - Street 2:SUITE E
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-7140
Practice Address - Country:US
Practice Address - Phone:425-379-6301
Practice Address - Fax:425-379-5761
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB27097Medicare ID - Type Unspecified