Provider Demographics
NPI:1134765449
Name:TAICLET, KENDRA (DC)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:TAICLET
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:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-0202
Mailing Address - Country:US
Mailing Address - Phone:620-228-2946
Mailing Address - Fax:
Practice Address - Street 1:1161 W VIRGINIA RD
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-1781
Practice Address - Country:US
Practice Address - Phone:620-228-2946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor