Provider Demographics
NPI:1457180440
Name:GARRETT, MIKAELA (DC)
Entity type:Individual
Prefix:
First Name:MIKAELA
Middle Name:
Last Name:GARRETT
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 1:7220 AVENIDA ENCINAS STE 206
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-4661
Mailing Address - Country:US
Mailing Address - Phone:760-803-7085
Mailing Address - Fax:
Practice Address - Street 1:7220 AVENIDA ENCINAS STE 206
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-4661
Practice Address - Country:US
Practice Address - Phone:760-803-7085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor