Healthcare Provider Details

I. General information

NPI: 1811260920
Provider Name (Legal Business Name): KYLE WARREN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 AMERICAN BLVD W SUITE 1500
BLOOMINGTON MN
55431-4420
US

IV. Provider business mailing address

3800 AMERICAN BLVD W SUITE 1500
BLOOMINGTON MN
55431-4420
US

V. Phone/Fax

Practice location:
  • Phone: 952-921-5858
  • Fax: 888-502-1176
Mailing address:
  • Phone: 952-921-5858
  • Fax: 888-502-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number5495
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: