Provider Demographics
NPI:1164491049
Name:KYLES, ANTONY HENDERSON (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTONY
Middle Name:HENDERSON
Last Name:KYLES
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 1:389 WOODLAKE DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-5002
Mailing Address - Country:US
Mailing Address - Phone:803-641-7394
Mailing Address - Fax:
Practice Address - Street 1:109 GREENVILLE ST SW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3810
Practice Address - Country:US
Practice Address - Phone:803-641-9102
Practice Address - Fax:803-649-4499
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGH1501Medicaid
SC571021803OtherPRACTICE ID