MEDICARE: KP CHIROPRACTIC PC

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	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0936060	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1699708594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KP CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	7450 BRIDGEWOOD BLVD
Second Line	:	SUITE 230
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-8274
Country	:	US
Telephone Number	:	515-201-0883
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 E THUNDERBIRD RD
Second Line	:	SUITE #1
City	:	PHOENIX
State	:	AZ
Zip	:	85022-5396
Country	:	US
Telephone Number	:	602-439-1515
Fax Number	:	602-439-1535

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. KYLE POHLMAN
Credential	:	D.C.
Telephone Number	:	515-221-0883

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	12/18/2007

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Directions to “KP CHIROPRACTIC PC ” Practice Location

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