MEDICARE: DR. THOMAS EVERETT KILEY 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	TK004039	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	950H350120	OTHER	MI	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578565743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS EVERETT KILEY D.C.

Provider Business Mailing Address
First Line	:	PO BOX 656
Second Line	:
City	:	CADILLAC
State	:	MI
Zip	:	49601-0656
Country	:	US
Telephone Number	:	231-775-1357
Fax Number	:	231-775-4709

Provider Business Practice Location Address
First Line	:	9116 E 13TH ST
Second Line	:
City	:	CADILLAC
State	:	MI
Zip	:	49601-8126
Country	:	US
Telephone Number	:	231-775-1357
Fax Number	:	231-775-4709

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	09/13/2016

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