MEDICARE: DR. MICHELLE LYNN DAVIDSON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH00034731	WA

General Provider Information

NPI Number	:	1679795439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE LYNN DAVIDSON D.C.

Provider Business Mailing Address
First Line	:	PO BOX 1030
Second Line	:
City	:	OLALLA
State	:	WA
Zip	:	98359-1030
Country	:	US
Telephone Number	:	253-857-2259
Fax Number	:

Provider Business Practice Location Address
First Line	:	7538 SE FRAGARIA RD
Second Line	:
City	:	OLALLA
State	:	WA
Zip	:	98359-9604
Country	:	US
Telephone Number	:	253-857-2259
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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