Provider Demographics
NPI:1679795439
Name:DAVIDSON, MICHELLE LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNN
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:POQUETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:OLALLA
Mailing Address - State:WA
Mailing Address - Zip Code:98359-1030
Mailing Address - Country:US
Mailing Address - Phone:253-857-2259
Mailing Address - Fax:
Practice Address - Street 1:7538 SE FRAGARIA RD
Practice Address - Street 2:
Practice Address - City:OLALLA
Practice Address - State:WA
Practice Address - Zip Code:98359-9604
Practice Address - Country:US
Practice Address - Phone:253-857-2259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor