Provider Demographics
NPI:1093069437
Name:SMITH, KYLE D (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:D
Last Name:SMITH
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 1:2121 BARRETT STATION RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1606
Mailing Address - Country:US
Mailing Address - Phone:636-385-8661
Mailing Address - Fax:
Practice Address - Street 1:2121 BARRETT STATION RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1606
Practice Address - Country:US
Practice Address - Phone:636-385-8661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8219055-1202111N00000X
MO2014033058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor