Provider Demographics
NPI:1275820326
Name:CAMPBELL, KYLE JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:JAY
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9727 POTEET JOURDANTON FWY
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78211-4574
Mailing Address - Country:US
Mailing Address - Phone:210-744-9870
Mailing Address - Fax:210-921-0398
Practice Address - Street 1:1313 SE MILITARY DR
Practice Address - Street 2:STE 107
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-2800
Practice Address - Country:US
Practice Address - Phone:210-744-9870
Practice Address - Fax:210-921-0398
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX8126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor