Provider Demographics
NPI:1154426609
Name:RANGER-DEAN, KAYLA (DC)
Entity type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:
Last Name:RANGER-DEAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55475 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MATTAWAN
Mailing Address - State:MI
Mailing Address - Zip Code:49071-8304
Mailing Address - Country:US
Mailing Address - Phone:269-668-4521
Mailing Address - Fax:269-668-4522
Practice Address - Street 1:55475 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MATTAWAN
Practice Address - State:MI
Practice Address - Zip Code:49071-8304
Practice Address - Country:US
Practice Address - Phone:269-668-4521
Practice Address - Fax:269-668-4522
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKR005892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4051784OtherBCBS OF IL
MI44-30154OtherIBA-UNITED HEALTH CARE
MI2892570Medicaid
MI950H05015OtherBCBS OF MI
MI950H05015OtherBCBS OF MI
MI44-30154OtherIBA-UNITED HEALTH CARE