Provider Demographics
NPI:1326104399
Name:KNUTSON, KYLA J (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLA
Middle Name:J
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KYLA
Other - Middle Name:J
Other - Last Name:CLAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:111 E MAIN ST
Mailing Address - Street 2:PO BOX 506
Mailing Address - City:BERESFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57004-1818
Mailing Address - Country:US
Mailing Address - Phone:605-763-8081
Mailing Address - Fax:605-763-8081
Practice Address - Street 1:111 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BERESFORD
Practice Address - State:SD
Practice Address - Zip Code:57004-1818
Practice Address - Country:US
Practice Address - Phone:605-763-8081
Practice Address - Fax:605-763-8081
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD951111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0008095OtherWELLMARK PROVIDER NUMBER
SD7601360Medicaid
SD14395OtherSVHP PROVIDER NUMBER
SD8095Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER