Provider Demographics
NPI:1598186421
Name:KAYELLO, IHAB ALEX (DC)
Entity Type:Individual
Prefix:DR
First Name:IHAB
Middle Name:ALEX
Last Name:KAYELLO
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 1:2633 E 15TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4744
Mailing Address - Country:US
Mailing Address - Phone:918-855-2033
Mailing Address - Fax:918-749-1187
Practice Address - Street 1:2633 E 15TH ST STE C
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4744
Practice Address - Country:US
Practice Address - Phone:918-855-2033
Practice Address - Fax:918-749-1187
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor