Healthcare Provider Details

I. General information

NPI: 1245616721
Provider Name (Legal Business Name): MARNIE HANSEN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3514 FREMONT AVE N
SEATTLE WA
98103-8814
US

IV. Provider business mailing address

3514 FREMONT AVE N
SEATTLE WA
98103-8814
US

V. Phone/Fax

Practice location:
  • Phone: 206-547-2057
  • Fax:
Mailing address:
  • Phone: 206-547-2057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH60082196
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60255486
License Number StateWA

VIII. Authorized Official

Name: MARNIE HANSEN
Title or Position: OWNER
Credential: DC
Phone: 206-634-1300