Healthcare Provider Details

I. General information

NPI: 1558132894
Provider Name (Legal Business Name): KATE KYLE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN KYLE DC

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 SW BARBUR BLVD STE 255
PORTLAND OR
97219-5440
US

IV. Provider business mailing address

660 2ND ST APT 10
LAKE OSWEGO OR
97034-2345
US

V. Phone/Fax

Practice location:
  • Phone: 503-226-8010
  • Fax:
Mailing address:
  • Phone: 805-300-2378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6358
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: