MEDICARE: DR. KYLE BROTHERTON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4163	OK

General Provider Information

NPI Number	:	1053711523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE BROTHERTON D.C.

Provider Business Mailing Address
First Line	:	1514 SW 119TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-4930
Country	:	US
Telephone Number	:	405-602-8925
Fax Number	:	405-604-3021

Provider Business Practice Location Address
First Line	:	1514 SW 119TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-4930
Country	:	US
Telephone Number	:	405-602-8925
Fax Number	:	405-304-3021

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2014
Last Update Date	:	06/18/2023

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