MEDICARE: DR. KYLE NOLAN WALSH DC

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	6451	MN

General Provider Information

NPI Number	:	1801304852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE NOLAN WALSH DC

Provider Business Mailing Address
First Line	:	33 AVON ST S APT 6
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-3186
Country	:	US
Telephone Number	:	630-667-3786
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 AVON ST S APT 6
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-3186
Country	:	US
Telephone Number	:	630-667-3786
Fax Number	:

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

Provider Enumeration Date	:	01/11/2018
Last Update Date	:	01/11/2018

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