=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821075896
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KYLE B PEPPLE D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2005
-----------------------------------------------------
Last Update Date | 05/30/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5830 CLARION ST SUITE 101
-----------------------------------------------------
City | CUMMING
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30040-0380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-947-4449
-----------------------------------------------------
Fax | 678-455-3655
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5830 CLARION ST SUITE 101
-----------------------------------------------------
City | CUMMING
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30040-0380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-947-4449
-----------------------------------------------------
Fax | 678-455-3655
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR006074
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------