Provider Demographics
NPI:1598969131
Name:LYLE A. MARCUS-LOVE
Entity Type:Organization
Organization Name:LYLE A. MARCUS-LOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCUS-LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-739-8882
Mailing Address - Street 1:12063 124TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-8204
Mailing Address - Country:US
Mailing Address - Phone:425-739-8882
Mailing Address - Fax:425-739-8886
Practice Address - Street 1:12063 124TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-8204
Practice Address - Country:US
Practice Address - Phone:425-739-8882
Practice Address - Fax:425-739-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1124051123Medicare UPIN