Provider Demographics
NPI:1629461074
Name:DESHOTEL, KAYLA SMITH (DC)
Entity Type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:SMITH
Last Name:DESHOTEL
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 1:811 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-2923
Mailing Address - Country:US
Mailing Address - Phone:318-410-9919
Mailing Address - Fax:318-410-9989
Practice Address - Street 1:811 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-2923
Practice Address - Country:US
Practice Address - Phone:318-410-9919
Practice Address - Fax:318-410-9989
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor