Provider Demographics
NPI:1336467315
Name:KATHALYNAS, ALLYSON LYNNE (D C)
Entity Type:Individual
Prefix:DR
First Name:ALLYSON
Middle Name:LYNNE
Last Name:KATHALYNAS
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E CHURCH ST STE A
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812-2239
Mailing Address - Country:US
Mailing Address - Phone:618-435-9393
Mailing Address - Fax:
Practice Address - Street 1:206 E CHURCH ST STE A
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-2239
Practice Address - Country:US
Practice Address - Phone:618-435-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor