Healthcare Provider Details

I. General information

NPI: 1790512432
Provider Name (Legal Business Name): KAYLA MICHELLE ANTHONY CH61608031
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18407 PACIFIC AVE S STE 11
SPANAWAY WA
98387-8375
US

IV. Provider business mailing address

18407 PACIFIC AVE S STE 11
SPANAWAY WA
98387-8375
US

V. Phone/Fax

Practice location:
  • Phone: 253-847-6000
  • Fax:
Mailing address:
  • Phone: 253-847-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License NumberCH61608031
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: