Healthcare Provider Details

I. General information

NPI: 1043189236
Provider Name (Legal Business Name): KYLE MCCARTHY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 WALNUT ST
FAIRFAX VA
22030-4726
US

IV. Provider business mailing address

5551 WALNUT GROVE CIR
STRUTHERS OH
44471-3116
US

V. Phone/Fax

Practice location:
  • Phone: 703-457-2337
  • Fax:
Mailing address:
  • Phone: 330-727-7985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104558152
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: