Healthcare Provider Details

I. General information

NPI: 1225799414
Provider Name (Legal Business Name): KYLE KEMP DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 CORPORATE WAY SE STE 102
PALM BAY FL
32909-3803
US

IV. Provider business mailing address

280 CORPORATE WAY SE STE 102
PALM BAY FL
32909-3803
US

V. Phone/Fax

Practice location:
  • Phone: 321-586-7145
  • Fax:
Mailing address:
  • Phone: 321-586-7145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number13867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: