Active NPI
Kaila Wildes Manshack, DC
- Chiropractor
- Shreveport, LA
National Provider Identifier
1396496816
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1937
- Practice address
- 8575 Fern Ave Ste 101
Shreveport, LA 71105-5677 - Phone
- (318) 797-2587
- NPI assigned
- Jan 17, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1937 | LA | Primary |
Addresses
Primary practice location
8575 Fern Ave Ste 101
Shreveport, LA 71105-5677
Mailing address
10115 Scarlet Oaks Dr
Keithville, LA 71047-7560
Phone (318) 470-1554
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1937 | LA | MD | Nutrition Education Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724371200000",
"number": "1396496816",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10115 SCARLET OAKS DR",
"city": "KEITHVILLE",
"state": "LA",
"postal_code": "710477560",
"telephone_number": "318-470-1554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8575 FERN AVE STE 101",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711055677",
"telephone_number": "318-797-2587"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANSHACK",
"first_name": "KAILA",
"middle_name": "WILDES",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-17",
"last_updated": "2024-08-23",
"certification_date": "2024-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "LA",
"license": "1937",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.