MEDICARE: DR. DOUGLAS W KYLE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NX0800X	Orthopedic Chiropractor	18851	CA

General Provider Information

NPI Number	:	1083605141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS W KYLE D.C.

Provider Business Mailing Address
First Line	:	300 TAMAL PLAZA
Second Line	:	SUITE 120
City	:	CORTE MADERA
State	:	CA
Zip	:	94925
Country	:	US
Telephone Number	:	415-924-1010
Fax Number	:	415-924-1016

Provider Business Practice Location Address
First Line	:	300 TAMAL PLAZA
Second Line	:	SUITE 120
City	:	CORTE MADERA
State	:	CA
Zip	:	94925
Country	:	US
Telephone Number	:	415-924-1010
Fax Number	:	415-924-1016

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	03/04/2020

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