Provider Demographics
NPI:1053711523
Name:BROTHERTON, KYLE (DC)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:BROTHERTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 SW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-4930
Mailing Address - Country:US
Mailing Address - Phone:405-602-8925
Mailing Address - Fax:405-604-3021
Practice Address - Street 1:1514 SW 119TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-4930
Practice Address - Country:US
Practice Address - Phone:405-602-8925
Practice Address - Fax:405-304-3021
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor