Provider Demographics
NPI:1720676398
Name:KANELAKOS, KADE DAVID (DC)
Entity type:Individual
Prefix:
First Name:KADE
Middle Name:DAVID
Last Name:KANELAKOS
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 1:10 LAKERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-4304
Mailing Address - Country:US
Mailing Address - Phone:620-446-0464
Mailing Address - Fax:
Practice Address - Street 1:10841 W 87TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-1660
Practice Address - Country:US
Practice Address - Phone:913-825-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty