Provider Demographics
NPI:1205242922
Name:VINCENT, KYLEIGH (DC)
Entity type:Individual
Prefix:
First Name:KYLEIGH
Middle Name:
Last Name:VINCENT
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 1:120 S DELMAR AVE
Mailing Address - Street 2:SUITE B P.O. BOX 458
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-2000
Mailing Address - Country:US
Mailing Address - Phone:618-740-1711
Mailing Address - Fax:618-740-1722
Practice Address - Street 1:120 S DELMAR AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-2000
Practice Address - Country:US
Practice Address - Phone:618-740-1711
Practice Address - Fax:618-740-1722
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor