Provider Demographics
NPI:1548569429
Name:LAM, MARK KHAI (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:KHAI
Last Name:LAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:KHAI
Other - Middle Name:
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1518 BISHOP RD SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-7354
Mailing Address - Country:US
Mailing Address - Phone:360-923-5588
Mailing Address - Fax:360-915-9815
Practice Address - Street 1:1518 BISHOP RD SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7354
Practice Address - Country:US
Practice Address - Phone:360-923-5588
Practice Address - Fax:360-915-9815
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60209984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor