Provider Demographics
NPI:1245265990
Name:MARSH, PATRICIA DIANE (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:DIANE
Last Name:MARSH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:DIANE
Other - Last Name:O'LAREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19201 108TH AVE SE
Mailing Address - Street 2:#101
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-7379
Mailing Address - Country:US
Mailing Address - Phone:253-859-6441
Mailing Address - Fax:253-859-9437
Practice Address - Street 1:19201 108TH AVE SE
Practice Address - Street 2:#101
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-7379
Practice Address - Country:US
Practice Address - Phone:253-859-6441
Practice Address - Fax:253-859-9437
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2011757Medicaid
WA124681OtherLABOR AND INDUSTRIES
WAMA5633OtherREGENCE BLUESHIELD
WAP00105987OtherRAILROAD MEDICARE
WA2011757Medicaid
WAP00105987OtherRAILROAD MEDICARE