Provider Demographics
NPI:1235346925
Name:BEANE, KYLE LESLIE (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:LESLIE
Last Name:BEANE
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 1:702B OAK ST.
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:MO
Mailing Address - Zip Code:64465
Mailing Address - Country:US
Mailing Address - Phone:816-740-6822
Mailing Address - Fax:816-528-6820
Practice Address - Street 1:702 OAK ST.
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:MO
Practice Address - Zip Code:64465
Practice Address - Country:US
Practice Address - Phone:816-740-6822
Practice Address - Fax:816-528-6820
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005021276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO36028017OtherBLUE CROSS
MO36028017OtherBLUE CROSS