Provider Demographics
NPI:1386780591
Name:KUYKENDALL, STEPHEN WAYNE (DC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:WAYNE
Last Name:KUYKENDALL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 KEELER CT
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77503-3530
Mailing Address - Country:US
Mailing Address - Phone:281-542-6991
Mailing Address - Fax:
Practice Address - Street 1:3203 PRESTON AVE STE C
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-2002
Practice Address - Country:US
Practice Address - Phone:281-998-1407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605048OtherBCBS
TX605048OtherBCBS
TX605048Medicare ID - Type Unspecified