Provider Demographics
NPI:1396952040
Name:ELLINGSEN, MARI LINDA (DC LMP)
Entity type:Individual
Prefix:MS
First Name:MARI
Middle Name:LINDA
Last Name:ELLINGSEN
Suffix:
Gender:F
Credentials:DC LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ON THE SQUARE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110
Mailing Address - Country:US
Mailing Address - Phone:206-842-6688
Mailing Address - Fax:206-842-6689
Practice Address - Street 1:2 ON THE SQUARE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110
Practice Address - Country:US
Practice Address - Phone:206-842-6688
Practice Address - Fax:206-842-6689
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3265111N00000X
WA6782225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
109378OtherDEPARTMENT OF LABOR AND
5001404OtherAETNA
911736082EL6082OtherREGENCE BLUE SHIELD
1306020OtherHIGHMARK BLUE SHIELD
653335OtherACN GROUP
U62210Medicare UPIN
109378OtherDEPARTMENT OF LABOR AND