Physician Compare National (NPI:1417049891)

HEALTHCARE PROVIDER: KYLE GOLTZ D.C.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1417049891
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5991697856
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101203001258
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GOLTZ
	Individual professional last name
Provider First Name	KYLE
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NORTHWESTERN COLLEGE OF CHIROPRACTIC
	Individual professional's medical school
Graduation Year	1999
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	425 YELLOWSTONE AVE
	Group Practice or individual's line 1 address
City	WEST YELLOWSTONE
	Group Practice or individual's city
State	MT
	Group Practice or individual's state
Zip Code	597589507
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M