Provider Demographics
NPI:1992411433
Name:PRUITT, KAYLA (DC)
Entity type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:
Last Name:PRUITT
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 1:15418 MAIN ST UNIT M106
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-9021
Mailing Address - Country:US
Mailing Address - Phone:425-742-6035
Mailing Address - Fax:
Practice Address - Street 1:15418 MAIN ST UNIT M106
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-9021
Practice Address - Country:US
Practice Address - Phone:425-742-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61268549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor