Healthcare Provider Details

I. General information

NPI: 1699364356
Provider Name (Legal Business Name): KAYLEA DAWN CANTRELL DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E PARK ST
GARDNER KS
66030-1343
US

IV. Provider business mailing address

122 E PARK ST
GARDNER KS
66030-1343
US

V. Phone/Fax

Practice location:
  • Phone: 913-286-4968
  • Fax:
Mailing address:
  • Phone: 918-740-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-06103
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: