Provider Demographics
NPI:1881744514
Name:DELISLE, MARISA ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:MARISA
Middle Name:ELIZABETH
Last Name:DELISLE
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 1:14709 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6547
Mailing Address - Country:US
Mailing Address - Phone:206-363-4478
Mailing Address - Fax:206-363-4640
Practice Address - Street 1:14709 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-6547
Practice Address - Country:US
Practice Address - Phone:206-363-4478
Practice Address - Fax:206-363-4640
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB40298Medicare ID - Type Unspecified