Provider Demographics
NPI:1114280336
Name:SPURLOCK, KYSKA DAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:KYSKA
Middle Name:DAWN
Last Name:SPURLOCK
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 1:8617 MID CITIES BOULEVARD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182
Mailing Address - Country:US
Mailing Address - Phone:682-551-4333
Mailing Address - Fax:
Practice Address - Street 1:8617 MID CITIES BOULEVARD
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182
Practice Address - Country:US
Practice Address - Phone:682-551-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX265780YMZQMedicare PIN