Provider Demographics
NPI:1336932284
Name:CUSHMAN, KYLIE (DC)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:CUSHMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:ELIZABETH
Other - Last Name:CUSHMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2318 N STURDEVANT ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-2243
Mailing Address - Country:US
Mailing Address - Phone:563-940-1866
Mailing Address - Fax:
Practice Address - Street 1:2377 CUMBERLAND SQUARE DR
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3251
Practice Address - Country:US
Practice Address - Phone:563-359-9541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA119421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor