Provider Demographics
NPI:1033282371
Name:BYRD, KARLA J (DC)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:J
Last Name:BYRD
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 1:109 S FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:POLO
Mailing Address - State:IL
Mailing Address - Zip Code:61064-1713
Mailing Address - Country:US
Mailing Address - Phone:815-946-9977
Mailing Address - Fax:
Practice Address - Street 1:109 S FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:POLO
Practice Address - State:IL
Practice Address - Zip Code:61064-1713
Practice Address - Country:US
Practice Address - Phone:815-946-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07130356OtherBLUE CROSS OF IL
IL07130356OtherBLUE CROSS OF IL