MEDICARE: DR. BRANDT KYLE BLIXT DC

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	01-06336	KS

General Provider Information

NPI Number	:	1104675487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDT KYLE BLIXT DC

Provider Business Mailing Address
First Line	:	1206 W 8TH ST
Second Line	:
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441-2038
Country	:	US
Telephone Number	:	785-762-6269
Fax Number	:

Provider Business Practice Location Address
First Line	:	1206 W 8TH ST
Second Line	:
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441-2038
Country	:	US
Telephone Number	:	785-762-6269
Fax Number	:

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

Provider Enumeration Date	:	05/17/2024
Last Update Date	:	05/17/2024

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