Provider Demographics
NPI:1225145022
Name:NYLAND, DAVID KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KENNETH
Last Name:NYLAND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 S PACKARD AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-1442
Mailing Address - Country:US
Mailing Address - Phone:414-483-4800
Mailing Address - Fax:414-483-0555
Practice Address - Street 1:4660 S PACKARD AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-1442
Practice Address - Country:US
Practice Address - Phone:414-483-4800
Practice Address - Fax:414-483-0555
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3448-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38905000Medicaid
WIU69050Medicare UPIN
WI38905000Medicaid