Provider Demographics
NPI:1811475551
Name:PRODANOVIC, MARINA
Entity type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:PRODANOVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:PRODANOVIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:6220 E LAKE SAMMAMISH PKWY SE
Mailing Address - Street 2:STE A
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-8925
Mailing Address - Country:US
Mailing Address - Phone:778-751-9889
Mailing Address - Fax:
Practice Address - Street 1:6220 E LAKE SAMMAMISH PKWY SE STE A
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-8925
Practice Address - Country:US
Practice Address - Phone:425-557-8787
Practice Address - Fax:425-557-6757
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60853453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor