Provider Demographics
NPI:1588867527
Name:TILLOTSON, MARC STEPHEN (DC)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:STEPHEN
Last Name:TILLOTSON
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 1:7923 STEILACOOM BLVD S.W.
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-6150
Mailing Address - Country:US
Mailing Address - Phone:253-584-2414
Mailing Address - Fax:
Practice Address - Street 1:7923 STEILACOOM BLVD SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-6150
Practice Address - Country:US
Practice Address - Phone:253-584-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU58373Medicare UPIN
WA115000666Medicare ID - Type Unspecified