Provider Demographics
NPI:1376870469
Name:ENSTAD, MICHAEL JON (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JON
Last Name:ENSTAD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7247 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-5900
Mailing Address - Country:US
Mailing Address - Phone:253-472-2225
Mailing Address - Fax:253-474-9596
Practice Address - Street 1:7247 S PINE ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-5900
Practice Address - Country:US
Practice Address - Phone:253-472-2225
Practice Address - Fax:253-474-9596
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60125744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor