MEDICARE: DR. KAILE RYAN MYRICK 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	CHR0007486	CO

General Provider Information

NPI Number	:	1700333200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAILE RYAN MYRICK D.C.

Provider Business Mailing Address
First Line	:	4730 CENTENNIAL BLVD
Second Line	:	STE 102
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3338
Country	:	US
Telephone Number	:	719-217-7453
Fax Number	:

Provider Business Practice Location Address
First Line	:	4730 CENTENNIAL BLVD
Second Line	:	STE 102
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3338
Country	:	US
Telephone Number	:	719-217-7453
Fax Number	:

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

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	03/23/2017

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