=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376106013
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAYLA KURDYLA DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2019
-----------------------------------------------------
Last Update Date | 04/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 BOWLING LN
-----------------------------------------------------
City | PELHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35124-4353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-988-9848
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 HAYESBURY LN
-----------------------------------------------------
City | PELHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35124-2720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-423-1899
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2604
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------