Healthcare Provider Details

I. General information

NPI: 1174736185
Provider Name (Legal Business Name): MARC ALAN IMLAY D.C. AND LAC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24625 148TH AVE. SE
KENT WA
98042-5227
US

IV. Provider business mailing address

24625 148TH AVE. SE
KENT WA
98042-5227
US

V. Phone/Fax

Practice location:
  • Phone: 253-630-1910
  • Fax: 253-630-1910
Mailing address:
  • Phone: 253-630-1910
  • Fax: 253-630-1910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00001662
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH00001662
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: