Healthcare Provider Details

I. General information

NPI: 1811187651
Provider Name (Legal Business Name): DAVID MICHAEL HYATT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6334 LITTLEROCK RD SW #101
TUMWATER WA
98512
US

IV. Provider business mailing address

6334 LITTLEROCK RD SW #101
TUMWATER WA
98512
US

V. Phone/Fax

Practice location:
  • Phone: 360-584-7004
  • Fax: 360-709-9220
Mailing address:
  • Phone: 360-584-7004
  • Fax: 360-709-9220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034045
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: