Provider Demographics
NPI:1508576992
Name:BAYLESS, MCKENNA (DC)
Entity Type:Individual
Prefix:DR
First Name:MCKENNA
Middle Name:
Last Name:BAYLESS
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 1:404 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:CANEY
Mailing Address - State:KS
Mailing Address - Zip Code:67333-2804
Mailing Address - Country:US
Mailing Address - Phone:605-413-9389
Mailing Address - Fax:
Practice Address - Street 1:110 N STATE ST
Practice Address - Street 2:
Practice Address - City:CANEY
Practice Address - State:KS
Practice Address - Zip Code:67333-1334
Practice Address - Country:US
Practice Address - Phone:605-413-9389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06208111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor