=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952591307
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KYLE HAMS D.C. P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2007
-----------------------------------------------------
Last Update Date | 10/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 E MAIN ST
-----------------------------------------------------
City | HINCKLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-384-6790
-----------------------------------------------------
Fax | 320-384-6836
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 543
-----------------------------------------------------
City | HINCKLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55037-0543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-384-6790
-----------------------------------------------------
Fax | 320-384-6836
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KYLE M HAMS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 320-384-6790
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2321
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------