Provider Demographics
NPI:1629215215
Name:MARTIN, LAELLE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:LAELLE
Middle Name:MARIE
Last Name:MARTIN
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 1:711 COURT A
Mailing Address - Street 2:SUITE100
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-5226
Mailing Address - Country:US
Mailing Address - Phone:253-503-8792
Mailing Address - Fax:253-503-8791
Practice Address - Street 1:711 COURT A
Practice Address - Street 2:SUITE100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5226
Practice Address - Country:US
Practice Address - Phone:253-503-8792
Practice Address - Fax:253-503-8791
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor