Provider Demographics
NPI:1265401970
Name:SPILLER, LARY GENE (DC)
Entity type:Individual
Prefix:MR
First Name:LARY
Middle Name:GENE
Last Name:SPILLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16809 REDMOND WAY
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4449
Mailing Address - Country:US
Mailing Address - Phone:425-883-2433
Mailing Address - Fax:425-861-0883
Practice Address - Street 1:16809 REDMOND WAY
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4449
Practice Address - Country:US
Practice Address - Phone:425-883-2433
Practice Address - Fax:425-861-0883
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00001720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
18251OtherL I
WA2007003Medicaid
WA2007003Medicaid