Healthcare Provider Details

I. General information

NPI: 1467517516
Provider Name (Legal Business Name): LAWRENCE DELISI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 HIGHWAY 20
WINTHROP WA
98862
US

IV. Provider business mailing address

PO BOX 723 517 HWY #20
WINTHROP WA
98862
US

V. Phone/Fax

Practice location:
  • Phone: 509-996-3276
  • Fax: 509-996-3276
Mailing address:
  • Phone: 509-996-3276
  • Fax: 509-996-3276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00002311
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: