Provider Demographics
NPI:1902314917
Name:DAUGHERTY, KYRA ARIEL (DC)
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:ARIEL
Last Name:DAUGHERTY
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 1:470 W 78TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-4525
Mailing Address - Country:US
Mailing Address - Phone:952-934-1772
Mailing Address - Fax:952-934-3114
Practice Address - Street 1:470 W 78TH ST STE 100
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4525
Practice Address - Country:US
Practice Address - Phone:952-934-1772
Practice Address - Fax:952-934-3114
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor