Provider Demographics
NPI:1821499732
Name:QUEEN, KAYLA (DC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:QUEEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:ST. AUBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:14471 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5401
Mailing Address - Country:US
Mailing Address - Phone:402-758-1088
Mailing Address - Fax:402-758-1099
Practice Address - Street 1:14471 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5401
Practice Address - Country:US
Practice Address - Phone:402-758-1088
Practice Address - Fax:402-758-1099
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1812111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor