Healthcare Provider Details

I. General information

NPI: 1144852500
Provider Name (Legal Business Name): TAICLET CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 W GARFIELD ST
IOLA KS
66749-1707
US

IV. Provider business mailing address

219 W GARFIELD ST
IOLA KS
66749-1707
US

V. Phone/Fax

Practice location:
  • Phone: 620-365-3000
  • Fax: 620-365-3001
Mailing address:
  • Phone: 620-365-3000
  • Fax: 620-365-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. KENDRA DANIELLE TAICLET
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 620-228-2946