Provider Demographics
NPI:1275934085
Name:ROSS, KYLE (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:ROSS
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 1:2130 W BELMONT AVE UNIT 6
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6990
Mailing Address - Country:US
Mailing Address - Phone:262-676-9370
Mailing Address - Fax:
Practice Address - Street 1:2130 W BELMONT AVE UNIT 6
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618
Practice Address - Country:US
Practice Address - Phone:262-676-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0.38.012686OtherDEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION