Provider Demographics
NPI:1467517516
Name:DELISI, LAWRENCE (DC)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:DELISI
Suffix:
Gender:M
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:PO BOX 723
Mailing Address - Street 2:517 HWY #20
Mailing Address - City:WINTHROP
Mailing Address - State:WA
Mailing Address - Zip Code:98862
Mailing Address - Country:US
Mailing Address - Phone:509-996-3276
Mailing Address - Fax:509-996-3276
Practice Address - Street 1:517 HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:WA
Practice Address - Zip Code:98862
Practice Address - Country:US
Practice Address - Phone:509-996-3276
Practice Address - Fax:509-996-3276
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor