Provider Demographics
NPI:1326000258
Name:KITTLE, WALTER PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:PAUL
Last Name:KITTLE
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 1:2385 DELHI COMMERCE DR
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-2192
Mailing Address - Country:US
Mailing Address - Phone:517-694-4972
Mailing Address - Fax:517-694-5898
Practice Address - Street 1:2385 DELHI COMMERCE DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-2192
Practice Address - Country:US
Practice Address - Phone:517-694-4972
Practice Address - Fax:517-694-5898
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWK004269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT32881Medicare ID - Type Unspecified
MIX24786Medicare UPIN