Provider Demographics
NPI:1053587808
Name:CHRISTENSEN, KYLE D (KYLE CHRISTENSEN)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:D
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:KYLE CHRISTENSEN
Other - Prefix:DR
Other - First Name:KYLE
Other - Middle Name:D
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1172 E 100 N STE 12
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-1668
Mailing Address - Country:US
Mailing Address - Phone:801-360-0749
Mailing Address - Fax:
Practice Address - Street 1:1172 E 100 N STE 12
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1668
Practice Address - Country:US
Practice Address - Phone:801-360-0749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17651111N00000X
UT7774355-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor