Provider Demographics
NPI:1245863117
Name:BERANEK, KAYLA (DC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:BERANEK
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 1:4832 HILLVALE AVE N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-2237
Mailing Address - Country:US
Mailing Address - Phone:763-360-9924
Mailing Address - Fax:
Practice Address - Street 1:4832 HILLVALE AVE N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-2237
Practice Address - Country:US
Practice Address - Phone:763-360-9924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor