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NPI Code Detail

MEDICARE: DR. KYLE BANNER D.C

MEDICARE: DR. KYLE BANNER 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
1111N00000XChiropractor2301010298MI

General Provider Information

NPI Number : 1366834780
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KYLE BANNER D.C
Provider Business Mailing Address
First Line : 1543 GLADSTONE DR SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49506-3922
Country : US
Telephone Number : 616-520-3430
Fax Number :
Provider Business Practice Location Address
First Line : 1543 GLADSTONE DR SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49506-3922
Country : US
Telephone Number : 616-520-3430
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2015
Last Update Date : 02/22/2015

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Directions to “ DR. KYLE BANNER D.C” Practice Location

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