Provider Demographics
NPI:1386425916
Name:WEIDER, MICAYLA (DC)
Entity type:Individual
Prefix:
First Name:MICAYLA
Middle Name:
Last Name:WEIDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20119 S PRAIRIE RD E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-7935
Mailing Address - Country:US
Mailing Address - Phone:253-862-1555
Mailing Address - Fax:253-862-1557
Practice Address - Street 1:20119 S PRAIRIE RD E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-7935
Practice Address - Country:US
Practice Address - Phone:253-862-1555
Practice Address - Fax:253-862-1557
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61500575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor