Provider Demographics
NPI:1821220369
Name:MOORE, KAITLIN MASAYE YAMANE (DC)
Entity Type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:MASAYE YAMANE
Last Name:MOORE
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:P.O. BOX 2545
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501
Mailing Address - Country:US
Mailing Address - Phone:360-352-0211
Mailing Address - Fax:
Practice Address - Street 1:2747 PACIFIC AVE SE
Practice Address - Street 2:SUITE B19
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2097
Practice Address - Country:US
Practice Address - Phone:360-352-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60092035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor