Provider Demographics
NPI:1407605926
Name:RYAN, KAYLA L (DC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:L
Last Name:RYAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:199 S ADDISON RD STE 106
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-1978
Mailing Address - Country:US
Mailing Address - Phone:630-766-1552
Mailing Address - Fax:630-766-4220
Practice Address - Street 1:199 S ADDISON RD STE 106
Practice Address - Street 2:
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-1978
Practice Address - Country:US
Practice Address - Phone:630-766-1552
Practice Address - Fax:630-766-4220
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL038014152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor