Provider Demographics
NPI:1114340015
Name:PRICE, KYLE WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:WILLIAM
Last Name:PRICE
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 1:634 B FAIRVIEW RD
Mailing Address - Street 2:STE 2
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680
Mailing Address - Country:US
Mailing Address - Phone:864-305-1009
Mailing Address - Fax:864-305-1009
Practice Address - Street 1:634 B FAIRVIEW RD
Practice Address - Street 2:STE 2
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680
Practice Address - Country:US
Practice Address - Phone:864-305-1009
Practice Address - Fax:864-305-1009
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDC3884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor