=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972360592
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATLYN TABOR DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/29/2024
-----------------------------------------------------
Last Update Date | 05/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11444 E CENTRAL AVE STE 202
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67206-2805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-241-9450
-----------------------------------------------------
Fax | 316-330-3892
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 S COUNTY RD
-----------------------------------------------------
City | HOLYROOD
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67450-9622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-789-0126
-----------------------------------------------------
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 | 01-06315
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------