Provider Demographics
NPI:1972360592
Name:TABOR, KATLYN (DC)
Entity type:Individual
Prefix:DR
First Name:KATLYN
Middle Name:
Last Name:TABOR
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:HOLYROOD
Mailing Address - State:KS
Mailing Address - Zip Code:67450-9622
Mailing Address - Country:US
Mailing Address - Phone:620-789-0126
Mailing Address - Fax:
Practice Address - Street 1:11444 E CENTRAL AVE STE 202
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2805
Practice Address - Country:US
Practice Address - Phone:316-241-9450
Practice Address - Fax:316-330-3892
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor