Provider Demographics
NPI:1457857963
Name:KALB, MICAH
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:KALB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 SE BAYSHORE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-4066
Mailing Address - Country:US
Mailing Address - Phone:360-389-2388
Mailing Address - Fax:
Practice Address - Street 1:830 SE BAYSHORE DR STE 201
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-4066
Practice Address - Country:US
Practice Address - Phone:360-389-2388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60764165171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist