Provider Demographics
NPI:1558457747
Name:GASIOROWSKI, KAYLYNNE M (DC)
Entity Type:Individual
Prefix:DR
First Name:KAYLYNNE
Middle Name:M
Last Name:GASIOROWSKI
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 1:2517 S 174TH PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2361
Mailing Address - Country:US
Mailing Address - Phone:402-578-5133
Mailing Address - Fax:
Practice Address - Street 1:5331 S 204TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-4385
Practice Address - Country:US
Practice Address - Phone:531-867-3720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010774111N00000X
NE1426111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK34137OtherMEDICARE #
IL1636348OtherBLUE CROSS ID #
IL1636348OtherBLUE CROSS ID #
ILV10967Medicare UPIN