Provider Demographics
NPI:1578256517
Name:WEIRICH, MICAH LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:LEE
Last Name:WEIRICH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 WALMART DR
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-3327
Mailing Address - Country:US
Mailing Address - Phone:636-208-6013
Mailing Address - Fax:
Practice Address - Street 1:405 WALMART DR
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-3327
Practice Address - Country:US
Practice Address - Phone:636-208-6013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023019496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor