Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CH00001662 | WA |
N | 111NN1001X | Nutrition | CH00001662 | WA |
NPI | 1174736185 |
---|---|
Provider Name | Dr. Marc Alan Imlay |
First Address | Kent, WA 98042-5227 |
Second Address | Kent, WA 98042-5227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 08/07/2007 |