Provider Demographics
NPI:1811444243
Name:WEAVER, MICHELLE YUKA (DC, IBCLC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:YUKA
Last Name:WEAVER
Suffix:
Gender:F
Credentials:DC, IBCLC
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:YUKA
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, IBCLC
Mailing Address - Street 1:3151 AIRWAY AVE STE F205
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4621
Mailing Address - Country:US
Mailing Address - Phone:949-228-9253
Mailing Address - Fax:949-299-0015
Practice Address - Street 1:3151 AIRWAY AVE STE F205
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4621
Practice Address - Country:US
Practice Address - Phone:949-228-9253
Practice Address - Fax:949-299-0015
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-315175174N00000X
CA33650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No174N00000XOther Service ProvidersLactation Consultant, Non-RN