=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922193424
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAYLA JO MADLER D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 04/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 S MAIN ST #101
-----------------------------------------------------
City | BURNS
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82053-0333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-547-3330
-----------------------------------------------------
Fax | 307-547-3339
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 333
-----------------------------------------------------
City | BURNS
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82053-0333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-547-3330
-----------------------------------------------------
Fax | 307-534-3339
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 718
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------