Provider Demographics
NPI:1639700909
Name:MCCANN, KYLAR SUE (DC)
Entity Type:Individual
Prefix:
First Name:KYLAR
Middle Name:SUE
Last Name:MCCANN
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 1:4200 MERCHANT ST STE 105
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5816
Mailing Address - Country:US
Mailing Address - Phone:573-777-5900
Mailing Address - Fax:573-777-5901
Practice Address - Street 1:4200 MERCHANT ST STE 105
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5816
Practice Address - Country:US
Practice Address - Phone:573-777-5900
Practice Address - Fax:573-777-5901
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020002798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor