Healthcare Provider Details

I. General information

NPI: 1144863853
Provider Name (Legal Business Name): KYLE DHUSE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W HYDRAULIC ST
YORKVILLE IL
60560-1408
US

IV. Provider business mailing address

9095 IMMANUEL RD
YORKVILLE IL
60560-9319
US

V. Phone/Fax

Practice location:
  • Phone: 630-699-2677
  • Fax:
Mailing address:
  • Phone: 630-699-2677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.013423
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: