Provider Demographics
NPI:1730886821
Name:KOMAREC, KAYLA ANN (DC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ANN
Last Name:KOMAREC
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 1:625 TRUMPETER TRL UNIT 7
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-7956
Mailing Address - Country:US
Mailing Address - Phone:262-308-5391
Mailing Address - Fax:
Practice Address - Street 1:502 GEORGE ST
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-2772
Practice Address - Country:US
Practice Address - Phone:920-337-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6056-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor