Healthcare Provider Details

I. General information

NPI: 1740587807
Provider Name (Legal Business Name): KEVIN CARSTEN SYKES D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7633 BELLAIRE DR S STE 101
FORT WORTH TX
76132-4311
US

IV. Provider business mailing address

7633 BELLAIRE DR S STE 101
FORT WORTH TX
76132-4311
US

V. Phone/Fax

Practice location:
  • Phone: 817-349-7541
  • Fax: 817-349-7549
Mailing address:
  • Phone: 817-349-7541
  • Fax: 817-349-7549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11678
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: