Provider Demographics
NPI:1528367364
Name:RIBELLIA, LISHA ANNEMARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:LISHA
Middle Name:ANNEMARIE
Last Name:RIBELLIA
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 1:26907 171ST PL SE
Mailing Address - Street 2:APT. L301
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-7332
Mailing Address - Country:US
Mailing Address - Phone:509-771-3925
Mailing Address - Fax:
Practice Address - Street 1:27203 216TH AVE SE
Practice Address - Street 2:SUITE 1
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-3273
Practice Address - Country:US
Practice Address - Phone:425-432-4621
Practice Address - Fax:425-432-6495
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60207934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor