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General NPI Number Information
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NPI Number | 1679952543
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Entity Type | Organization
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Legal Business Name | MIKAYLA LONG
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 20110 TVEIT RD
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City | ARLINGTON
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State | WA
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Zip | 98223-5937
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Country | US
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Telephone | 425-330-4462
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Fax |
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Provider Business Mailing Address
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Address Line | 20110 TVEIT RD
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City | ARLINGTON
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State | WA
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Zip | 98223-5937
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Country | US
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Telephone | 425-330-4462
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | MRS. MIKAYLA SUE LONG
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Credential |
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Telephone | 425-330-4462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | MA60560891
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License Number State | WA
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