Provider Demographics
NPI:1619604584
Name:PADILLA, KAYLIE MARIE (DC)
Entity Type:Individual
Prefix:
First Name:KAYLIE
Middle Name:MARIE
Last Name:PADILLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KAYLIE
Other - Middle Name:M
Other - Last Name:PADILLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1720 S 72ND ST STE 102
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-1297
Mailing Address - Country:US
Mailing Address - Phone:253-472-4424
Mailing Address - Fax:253-471-9806
Practice Address - Street 1:1720 S 72ND ST STE 102
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-1297
Practice Address - Country:US
Practice Address - Phone:253-472-4424
Practice Address - Fax:253-471-9806
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61300439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor