MEDICARE: DR. KYLE EDWARD WALTZ 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	1539	LA
2	111N00000X	Chiropractor	3977	NC

General Provider Information

NPI Number	:	1386875284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE EDWARD WALTZ D.C.

Provider Business Mailing Address
First Line	:	1341 E MOREHEAD ST
Second Line	:	STE 101
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2936
Country	:	US
Telephone Number	:	704-940-7740
Fax Number	:	704-243-8403

Provider Business Practice Location Address
First Line	:	1341 E MOREHEAD ST
Second Line	:	STE 101
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2936
Country	:	US
Telephone Number	:	704-940-7740
Fax Number	:	704-843-8403

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

Provider Enumeration Date	:	07/27/2009
Last Update Date	:	04/29/2020

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