Provider Demographics
NPI:1851663983
Name:NEIBAUER, KAYLA ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:ROSE
Last Name:NEIBAUER
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 1:3831 LOCKPORT ST B
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-5539
Mailing Address - Country:US
Mailing Address - Phone:701-751-3454
Mailing Address - Fax:
Practice Address - Street 1:3831 LOCKPORT ST B
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-5539
Practice Address - Country:US
Practice Address - Phone:701-751-3454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND899111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
N722013Medicare PIN