Provider Demographics
NPI:1134743792
Name:ALVAREZ, KAILA (DC)
Entity type:Individual
Prefix:
First Name:KAILA
Middle Name:
Last Name:ALVAREZ
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 1:107 GRANDVIEW CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-2329
Mailing Address - Country:US
Mailing Address - Phone:920-344-0119
Mailing Address - Fax:
Practice Address - Street 1:107 GRANDVIEW CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:WI
Practice Address - Zip Code:53925-2329
Practice Address - Country:US
Practice Address - Phone:920-344-0119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2022-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6746111N00000X
WI5731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor