Provider Demographics
NPI:1396496816
Name:MANSHACK, KAILA WILDES (DC)
Entity type:Individual
Prefix:
First Name:KAILA
Middle Name:WILDES
Last Name:MANSHACK
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 1:10115 SCARLET OAKS DR
Mailing Address - Street 2:
Mailing Address - City:KEITHVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71047-7560
Mailing Address - Country:US
Mailing Address - Phone:318-470-1554
Mailing Address - Fax:
Practice Address - Street 1:8575 FERN AVE STE 101
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5677
Practice Address - Country:US
Practice Address - Phone:318-797-2587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1937111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor