MEDICARE: DR. KYLE THOMAS ORDILLE 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	5030	SC

General Provider Information

NPI Number	:	1437998911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE THOMAS ORDILLE DC

Provider Business Mailing Address
First Line	:	171 3RD AVE APT C
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29403-3673
Country	:	US
Telephone Number	:	717-743-7138
Fax Number	:

Provider Business Practice Location Address
First Line	:	907 HOUSTON NORTHCUTT BLVD
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3448
Country	:	US
Telephone Number	:	717-743-7138
Fax Number	:

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

Provider Enumeration Date	:	05/23/2024
Last Update Date	:	04/08/2025

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