Provider Demographics
NPI:1093999260
Name:DR. KYLE W DOAN DC
Entity Type:Organization
Organization Name:DR. KYLE W DOAN DC
Other - Org Name:DR. KYLE W DOAN DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:W
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-957-9148
Mailing Address - Street 1:1633 BOATHOUSE CIR APT HA234
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-8966
Mailing Address - Country:US
Mailing Address - Phone:941-957-9148
Mailing Address - Fax:941-218-4464
Practice Address - Street 1:7725 HOLIDAY DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-5313
Practice Address - Country:US
Practice Address - Phone:941-957-8148
Practice Address - Fax:941-218-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT53103Medicare UPIN
NYAA1605Medicare PIN
NYDC0890Medicare PIN
NYDD5501Medicare PIN
NYP00147190Medicare PIN