Provider Demographics
NPI:1124051123
Name:MARCUS-LOVE, LYLE ARDON (DC)
Entity type:Individual
Prefix:DR
First Name:LYLE
Middle Name:ARDON
Last Name:MARCUS-LOVE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 KIRKLAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6503
Mailing Address - Country:US
Mailing Address - Phone:425-739-8882
Mailing Address - Fax:425-739-8886
Practice Address - Street 1:207 KIRKLAND AVE STE B
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6503
Practice Address - Country:US
Practice Address - Phone:425-739-8882
Practice Address - Fax:425-739-8886
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3616MAOtherREGENCE PROVIDER #
WA12-09932-001OtherCIGNA PROVIDER #
WA133803OtherL&I #
WA7668140OtherAETNA PROVIDER #
WA7668140OtherAETNA PROVIDER #
WA3616MAOtherREGENCE PROVIDER #