Provider Demographics
NPI:1356589477
Name:LIES, LYNNA M (DC)
Entity type:Individual
Prefix:DR
First Name:LYNNA
Middle Name:M
Last Name:LIES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10024 MAIN ST
Mailing Address - Street 2:SUITE #2C
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3464
Mailing Address - Country:US
Mailing Address - Phone:425-485-1413
Mailing Address - Fax:425-485-1283
Practice Address - Street 1:10024 MAIN ST
Practice Address - Street 2:SUITE #2C
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3464
Practice Address - Country:US
Practice Address - Phone:425-485-1413
Practice Address - Fax:425-485-1283
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA 1349111N00000X
WACH60058655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor