MEDICARE: MR. STEPHEN WAYNE KUYKENDALL DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC5272	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	605048	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1386780591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN WAYNE KUYKENDALL DC

Provider Business Mailing Address
First Line	:	4111 KEELER CT
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77503-3530
Country	:	US
Telephone Number	:	281-542-6991
Fax Number	:

Provider Business Practice Location Address
First Line	:	3203 PRESTON AVE STE C
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77505-2002
Country	:	US
Telephone Number	:	281-998-1407
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. STEPHEN WAYNE KUYKENDALL DC” Practice Location

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